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Full text of "U.S. Navy Medicine Volume 68, Number 10 October 1977"

VADM WUIard P. Arentzen, MC, USN 
Surgeon General of the Navy 

RADMR.G.W. Williams, Jr., MC, USN 

Deputy Surgeon General 

EDITOR 

Sylvia W. Shaffer 

MANAGING EDITOR 

June Wyman 

ASSISTANT EDITOR 

Virginia M. Novinski 

EDITORIAL ASSISTANT 

Nancy R. Keesee 

CONTRD3TJTING EDITORS 

Contributing Editor-in ■ Chief: 
CDR C.T. Cloutier (MC) 
Aerospace Medicine: CAPT M.G. Webb 
(MC); Dental Corps: CAPT R.D. Ulrey (DC); 
Education: CAPT S.J. Kreider (MC); Fleet 
Support: LCDR J.D. Schweitzer (MSC); 
Gastroenterology: CAPT D.O. Castell 
(MC); Hospital Corps: HMCM H.A. 
Olszak; legal: LCDR R.E. Broach 
(JAGC); Marine Corps: CAPT D.R. Hauler 
(MC); Medical Service Corps: IT J.M. 
Cooper (MSC); Naval Reserve: CAPT J.N. 
Rizzi (MC, USN); Nephrology: CDR J.D. 
Wallin (MC); Nurse Corps: CAPT P.J. 
Elsass (NC); Occupational Medicine: CAPT 
G.M. Lawtoti (MC); Preventive Medicine: 
CAPT D.F. Hoeffler (MC); Psychiatry: 
CAPT S.J. Kreider (MC); Research: CAPT 
J. P. Bloom (MC); Submarine Medicine: 
CAPT H.E. Glick (MC) 

POLICY: U.S. Navy Medicine is an official publication 
of the Navy Medical Department, published by the Bureau 
of Medicine and Surgery. It disseminates to Navy Medical 
Department personnel official and professional information 
relative to medicine, dentistry, and the allied health sd 
ences. Opinions expressed are those of the authors and do 
not necessarily represent the official position of the Depart- 
ment of the Navy, the Bureau of Medicine and Surgery, or 
any other governmental department or agency. Trade 
names are used for identification only and do not represent 
an endorsement by the Department of the Navy or the Bu- 
reau of Medicine and Surgery. Although U.S. Navy Medi- 
cine may cite or extract from directives, official authority for 
action should he obtained from the cited reference. 

DISTRIBUTION: U.S. Navy Medicine is distributed to 
active-duty Medical Department personnel via the Standard 
Navy Distribution List. The following distribution is author- 
ized: one copy for each Medical. Dental, Medical Service 
and Nurse Corps officer; one copy fot every 10 enlisted 
Medical Department members. Requests to increase or de- 
crease the number of allotted copies should be forwarded to 
U.S. Navy Medicine via the local command. 

CORRESPONDENCE: All correspondence should be 
addressed to: Editor, U.S. Navy Medicine, Department of 
the Navy, Bureau of Medicine and Surgery (Code 0010), 
Washington, D.C. 20372. Telephone: (Area Code 202) 
254-4253, 254-4316, 254-4214; Autovon 294-4253, 294-4316, 
294-4214. Contributions from the field are welcome and will 
be published as space permits, subject to editing and pos- 
sible abridgment. 

The issuance of this publication is approved in accor- 
dance with Department of the Navy Publications and 
Printing Regulations (NAVEXOS P-.15!. 



NAVMED P-5088 



1.S.MVY 




Volume 68, Number 10 
October 1977 



1 From the Surgeon General 

2 Department Rounds 

FDA licenses Navy blood banks 

4 Interview 

CAPT Jay Cox, director of sports medicine at Naval Academy, 
discusses sports injuries 

11 Roster — 1 September 1977 

Staff medical and dental officers at major activities 

15 NAVMED Newsmakers 

16 Off Duty 

Meet Dr. All Thumbs 

18 Scholars' Scuttlebutt 

Taxes: What's in store for AFHPSP students? 



19 BUMED SITREP 

20 Policy 

Nonflammable medical gas systems . , 

23 Notes and Announcements 

Dental continuing education courses 
education courses approved 



Instructions and directives 



Nurse Corps continuing 



24 Clinical Notes 

Cannulating Wharton's Duct During Biopsy 
CAPTE.L. Mosby, DC, USN 

25 Hypertension Screening Aboard Ship 
LCDR E.W. Massey, MC, USN Ft 

26 Professional 

The Efficacy of the CM I and MMPI as Predictors of Successful 
Completion of Psychiatric Technician Training 
LT J.J. Penkunas, MSC, USN 
CAPT J. F. McGrail, MC, USN 

COVER: Not all Navy athletes are subject to the crushing blows of 
football, but every sport has its own physical stresses. Result: 864 
sports- related injuries reported for Navy men and women last year. 
Beginning on page 4, CAPT Jay Cox (MC), director of sports medicine 
at the Naval Academy, tells Medical Department members how to care 
for and prevent these injuries. (Photo courtesy of Naval Academy 
Sports Information Office.) 



From the Surgeon General 



Hospital Corpsmen: 

They Deserve Better 



THERE IS AN old saying that noth- 
ing is too good for our enlisted per- 
sonnel and nothing is what they get. 
While not literally true, it's close 
enough to give us pause. 

It is the skill, knowledge, hard 
work and dedication of the young 
men and women of the Hospital 
Corps that makes our system work. 
Without them we could not operate. 

Lack of adequate numbers of 
ancillary personnel is among the 
reasons I most commonly hear for 
physicians wishing to leave the 
Navy. Every day letters and mes- 
sages come across my desk concern- 
ing some shortage among our Hos- 
pital Corps community— operating 
room technicians, biomedical equip- 
ment repair technicians, laboratory 
technicians, and so forth. We train 
them and they leave us. 

In the course of my travels I rou- 
tinely meet with enlisted personnel. 
The concerns they express are the 
same almost everywhere. Many of 
these problems are beyond our con- 
trol. But the most frequently ex- 
pressed concern, and the one which 
distresses me most, is the apparent 
lack of communication between the 
Command and the staff. 

I encourage regular meetings of 
Command and staff to improve com- 
munication. I have also directed 
that unnecessary watches be elimi- 
nated. And I have directed renewed 



efforts toward patient education — 
to teach our patients that they have 
some responsibility for their own 
health care. These things will help. 

We must make the lives of our 
enlisted personnel better. We can't 
increase their pay but we can cer- 
tainly show we appreciate their ser- 
vice. When was the last time you 
recommended a hospital corpsman 
for a medal? When was the last time 
you said thank you? 

These young men and women are 
Navy medicine. They know it; let's 
let them know that we know it. For 
too long we have accepted their 
service as a matter of course. They 
deserve better! 



ji./> 




W.P. ARENTZEN 

Vice Admiral, Medical Corps 

United States Navy 




The Surgeon General talks with E-5's and below at NRMC 
Charleston, S.C. 



Volume 68. October 1977 




Corpsmen pack frozen blood plasma for victims of airplane crash in Canary Islands 



Department Rounds 

Blood Program 

No. 635: License for Top Care 



By the end of the year, all full- 
service Navy blood banks and blood 
donor centers in the U.S. will be 
licensed by the Food and Drug 
Administration, 

LCDR James F. Bates (MSC), 
head of the Navy Blood Program, 
sees two major advantages: "First, 
licensure will allow us to exchange 
blood and blood components more 
freely and quickly with civilian 
blood banks. For example, for the 
first time we will be able to 
exchange blood with civilian blood 
banks across state lines, as we now 
do with other military blood banks. 

"Second, by integrating certain 
aspects of the military blood pro- 
gram with the civilian program, we 
can help develop one nationwide 
system that will have uniform 
standards of quality and safety," 

Common policy. According to 
LCDR Bates, the three-year journey 
toward licensure began back in 
June 1974, when the FDA and the 



Department of Defense agreed to a 
common policy for licensing military 
blood banks under Section 351 of 
the Public Health Service Act. Each 
military service, it was agreed, 
would voluntarily apply to the FDA 
for a license to manufacture blood 
and blood components. The military 
departments also agreed to ensure 
that their licensed blood banks meet 
all prescribed standards and oper- 
ate in accordance with FDA regula- 
tions. 

While licenses granted military 
blood banks are the equivalent of 
civilian licenses, the FDA took into 
account DOD's unique defense 
mission: provisions were made to 
ensure the agreement would not 
compromise DOD ability to meet 
military requirements for blood. 

The Navy's efforts to obtain licen- 
sure were carried out in two phases, 
the first beginning in November 
1974. 

"In Phase I, we obtained licenses 



for our five regional blood coordi- 
nating centers," explains LCDR 
Bates. "We are now in Phase II, in 
which 13 other selected CONUS 
blood banks will be licensed." 

Already licensed under U.S. Li- 
cense 635 are blood banks at Naval 
Regional Medical Centers San Die- 
go, Portsmouth, Orlando, Camp 
Pendleton, Bremerton, Oakland, 
Long Beach, Great Lakes, Memphis 
and Newport, as well as at the 
National Naval Medical Center in 
Bethesda, the Naval Aerospace and 
Regional Medical Center in Pensa- 
cola, and Naval Hospital Beaufort, 
S.C. By 31 December, licensure is 
expected to be obtained for blood 
banks at NRMCs Charleston, Jack- 
sonville, Philadelphia, Camp Le- 
jeune and Corpus Christi. 

Inspections. As LCDR Bates ex- 
plains the procedure, commanding 
officers of each Navy facility se- 
lected for FDA licensure submitted 
an application for their facility and 
for each blood product. "The FDA 
then reviewed the applications and 
sent a representative to do a pre- 
licensure inspection," LCDR Bates 
says. "The FDA gave each facility a 
list of any discrepancies found dur- 
ing the inspection, and later the 
facility sent back to the FDA a letter 
explaining how each discrepancy 
was corrected." Only when the 
FDA was satisfied that a blood bank 
and all blood products manufac- 



RED BLOOD CELLS (HUMAN) 

PREPARED FROM APPR0X.450 ml WHOLE BLOOD COLLECTED 
IN S3 ml ANTICOAGULANT CPD SOLUTION. LLS.P 

NO EVIDENCE OF IRREGULAR ANTIBODIES DETECTED WHEN TESTED 

WITH REAGENT RED BLOOD CELLS IHUMAN1 BY MULTIPLE TECHNIQUE! 

SEROLOGICALLY NONREACTIVE BV ART 

NONREACTIVE FOR HEPATITIS B SURFACE ANTIGEN BY RIA 



Rh NEGATIVE 

WHEN TESTED FOR Rh„ (Dt AND WEAK Rh.. VARIANT (D" 



CAUTIONS: 

1 STORE WITHIN A 2 DEGRE 

2 CROSSMATCH BEFORE Tfli 

3 IDENTIFY RECIPIENT AS P/ 
4.00 NOT ADD MEDICATION: 

5. MIX BLOOD THOROUGHLY 

6. INFUSION SET MUST HAVI 

7 SEE CIRCULAR FORFURTi 

8 FEDEHAL LAW PROHIBITS 
9. WARNING: THE RISK OF 

WARRANTIES OF FITNES! 
MADE. ALL WARRANTIES 



ISOAGGLUTINII 



BUREAU OF MEDICINE 

ANDSUHGERY 
NAVY DEPARTMENT 
WASH., D.C. 20372 
U.S. LICENSE NO. 835 




EEN1 AND 6 DEGREES C 

.SS MATCH 

EF0P.EUSE 

OTVENT 

NS. 

ITHOUTA PRESCRIPTION 
HEPATITIS IS PRESENT Nl 
ILITY. OR OTHERWISE. AR 
PLIED ARE EXCLUDED. 

DETERMINED 



NAVAL REGIONAL 

MEDICAL CENTER 

BLOOD BANK 

SAN DIEGO. 

CALIFORNIA 921 34 



New Navy blood bag label 



U.S. Navy Medicine 



tured there complied with FDA 
rules and regulations, would the 
command be permitted to use the 
common Navy license number on its 
blood and blood products. 

According to LCDR Bates, Navy 
blood banks will be alerted in ad- 
vance of pre-licensure inspections. 
Once licensed, however, they will 
be subject to unannounced annual 
inspections by the FDA, as well as 
inspections by representatives of 
the Bureau of Medicine and Sur- 
gery. 

Licenses will be valid until sus- 
pended or revoked, or until military 
operations require deviation from 
FDA blood banking regulations. 
The Commissioner of Food and 
Drugs can recommend that a license 
be suspended or revoked if: 

• FDA inspectors are unable to 
gain access to a facility. 

• Product manufacturing has been 
discontinued to the point that a 
meaningful inspection cannot be 
made. 

• The facility fails to conform to 
federal regulations. 

A license will be suspended until 
the faults are corrected, and re- 
voked if conditions are not put right 
within 60 days. 

Parity. FDA licensure has already 
improved the Navy's Blood Pro- 
gram. Formerly, civilian blood 
banks in the State of California 
could not accept blood from Navy 
blood banks there because the Navy 
facilities were not licensed under 
California biologic laws and regula- 
tions. But ever since FDA licensure 
was obtained for most Navy blood 
banks in California, the situation 
has changed: the current stand is 
that, as federal enclaves exempt 
from California control, licensed 
Navy blood banks will be dealt with 
as are civilian FDA-licensed blood 
banks outside the state. So if a Navy 
blood bank is licensed by FDA to 
exchange across state lines, civilian 
blood banks in California can now 
accept its products. 

Also, the American National Red 
Cross, which until now would not 
officially accept blood products from 
Navy facilities, is negotiating with 



BUMED to develop a blood ex- 
change program. 

"These changes are the begin- 
ning of official recognition that will 
give the Navy's blood banks parity 
with the rest of the nation's blood 
banking organizations," LCDR 
Bates says. "This will make it 
easier for us to exchange blood with 
the civilian community, and help us 
manage our blood resources better. 
It may also help expand the 
CHAMPUS [Civilian Health and 
Medical Program of the Uniformed 
Services] blood credit exchange pro- 
gram in the Navy." 

Benefits. FDA regulations im- 
posing specific requirements for the 
safety, purity, and potency of blood 
and blood products have brought 
the Navy a number of benefits, 
LCDR Bates reports. For example, 
although the incidence of post- 
transfusion hepatitis is minimal in 
the Navy and the number of units of 
Navy-donated blood that contains 
hepatitis B surface antigen (HBsAg) 
is less than 1%, FDA regulations 
require more sensitive methods of 
HBsAg testing than the Navy was 
routinely using. "Navy blood banks 
in the U.S. are now screening all 
units of blood for HBsAg using 
methods of third-generation sensi- 
tivity," LCDR Bates reports. "With 
these procedures, we will be able to 
identify an increased number of 
blood donors who carry this specific 
hepatitis antigen. The result will be 
fewer incidents of post-transfusion 
hepatitis." 

Better care for Navy patients is 
also assured by strict administrative 
controls called for in FDA regula- 
tions. For example, the FDA re- 
quires that there be a means of 
rapidly locating all components 
prepared from a unit of blood. 
LCDR Bates explains the impor- 
tance of this requirement: "If after 
donating blood an individual is 
found to have a contagious disease, 
the unit of blood he donated and 
each component prepared from that 
blood can be traced to the recipient 
or to the place where the compo- 
nents are stored. We can also use 
these same tracking procedures to 



notify donors that they might be ill, 
should a recipient develop a trans- 
fusion-related disease." 

The FDA also requires licensed 
blood banks to monitor the quality 
of reagents, supplies, and tech- 
niques used to manufacture and 
process blood and components. 
While quality control has always 
been part of Navy blood bank pro- 
cedures, the strict FDA regulations 
will ensure that maximum controls 
are imposed. 

"These controls will require 
closer administrative supervision, 
and in some instances may increase 
the blood bank workload," LCDR 
Bates says. "But the benefits to our 
patients are worth the extra effort. 
We'll also be able to point to out- 
standing quality assurance meas- 
ures should our blood program ever 
be involved in litigation." 

LCDR Bates also believes that the 
common forms, records, blood bag 
labels and procedures required by 
the FDA will make it easier for Navy 
laboratory technicians to adapt to 
new duty assignments. "When all 
Navy blood banks are operating un- 
der common standards, the break- 
in period for new personnel will be 
minimal and there will be a smooth- 
er changeover of blood bank staff," 
he says. 

Before licensure was sought, 
each Navy blood bank used its own 
blood bag labels — a practice unac- 
ceptable to the FDA, Now, a single 
style of label is used in all Navy 
blood banks in the U.S. Result: 
elimination of much of the confusion 
physicians and blood bank person- 
nel previously encountered deter- 
mining product names, transfusion 
precautions, blood groups, and 
other essential information. 

"We can look for more benefits 
from FDA licensure," LCDR Bates 
predicts. ' T think the annual inspec- 
tions will give our regional area 
blood system coordinators greater 
awareness of problems within the 
Navy Blood Program. Also, tri- 
service cooperation will be im- 
proved when military blood banks 
and blood donor centers meet re- 
quirements for FDA licensure." 



Volume 68, October 1977 



r> «V- g f 



%V*B 




tau*» 



Interview 



Contact sports such as football cause many injuries each year 



Down . . . ready ... set 



Hup-hup-hup! Oof! Thud! Hey, Doc! 



Navy and Marine Corps athletes 
come in all shapes, sizes, and levels 
of competence — from Naval Acad- 
emy midshipmen lauded on sports 
pages to desk-bound duffers who 
dream of breaking 100. Whatever 
their level of expertise, many who 
join in the games get hurt. 

Statistics compiled by the Naval 
Safety Center, Norfolk, Virginia, 
show that naval activities last year 
reported 846 sports-related injuries: 

508 associated with ball games, 
including basketball, baseball, and 
football; 



This interview was conducted by CDR 
Douglas W. Peterson (MC), a staff member 
at the Bureau of Medicine and Surgery. 



18 from parachuting and gliding; 

22 from winter sports, such as 
skiing, skating, and sledding; 

50 from water sports; 

248 resulting from other sports, 
including hiking, camping, bicy- 
cling, gymnastics, and wrestling. 

Safety Center officials believe the 
number of injuries was probably 
much higher, since many minor in- 
juries are not reported. 

The records also reveal a more 
somber statistic: 51 sports-related 
deaths reported during 1976, most 
of them associated with water 
sports. 

Because so many Navy and 
Marine Corps men and women take 
part in sports, Medical Depart- 



ment members — especially hospital 
corpsmen serving on independent 
duty — may find it helpful to know 
something about sports medicine. 
Prompt treatment of injuries — or 
better yet, proper conditioning of all 
participants — can help reduce the 
number of man-days lost each year 
due to athletic wear and tear. 

U.S. Navy Medicine asked CAPT 
Jay S. Cox (MC), director of sports 
medicine at the Naval Academy and 
chief of the Orthopedic Department 
at Naval Hospital, Annapolis, for 
pointers on preventing and treating 
sports injuries. 

USNM: CAPT Cox, how did you get 
involved in sports medicine? 



U.S. Navy Medicine 




Tennis elbow can result from overexer- 
tion of forearm extensor muscles 



CAPT Cox: I was originally inter- 
ested in children's orthopedics in 
the days when many children still 
had residual effects from polio. 
After the vaccines eliminated most 
of the polio problems, my interest 
switched to sports medicine. I 
served as team physician for the 
Capital Bullets basketball team in 
1966 when they were still in Balti- 
more. Later I was associated with 
the Oakland Raiders while I was sta- 
tioned at Naval Hospital Oakland, 
and served as their assistant ortho- 
pedic consultant from 1970 through 
1972. Since 1974 I have been chief 
of orthopedics at Naval Hospital An- 
napolis and director of sports medi- 
cine at the Naval Academy. I am 
also the team physician for varsity 
football, basketball, lacrosse, and 
baseball. My two associates in the 
Orthopedics Department cover the 
many other athletic teams at the 
Academy. 



Stress syndromes of lower legs plague joggers (left) and other Navy athletes 




Dr. Cox examines athlete's ankle in Naval Academy's training room 



Volume 68, October 1977 



Did you have any formal training 
in sports medicine? 

No, at that time there was no for- 
mal training in sports medicine. I 
learned through the school of hard 
knocks — through experience, read- 
ing, and sharing colleagues' experi- 
ences. There are now some fellow- 
ships available in sports medicine. 

What injuries are especially com- 
mon in sports? 

Stress syndromes of the foot, 
ankle, and lower leg are common, 
especially in the running sports 
such as jogging. Many of these in- 
juries occur from running on hard 
surfaces, such as the heavy steel 
decks on Navy ships. When the foot 
is subjected to stress, there can be 
problems such as tendinitis, heel 
pain, ankle pain, shin splints, and 
stress fractures. Sometimes the 
stress is transmitted to the knee and 
is reflected by soreness and tender- 
ness, particularly around the knee- 
cap. 

One of the commonest stress 
syndromes is pain along the longi- 
tudinal arch of the foot. This occurs 
when an athlete comes down hard 
on the longitudinal arch. Good sup- 
portive shoes are probably the best 
way to prevent this type of injury. 

You mentioned stress syndromes 
of the ankle. Are there different 
kinds of ankle sprains? 

Approximately 15% of ankle 
sprains are the eversion or outward- 
twisting type. This is the most seri- 
ous and devastating type of non- 
fracture ankle injury, and it requires 
early treatment by a physician. 

The other type of ankle sprain, 
comprising about 85% of ankle liga- 
ment injuries, is the inversion, 
plantar flexion type of sprain. This 
is the injury that occurs when a 
basketball or volleyball player twists 
the foot and ankle inward. The liga- 
ments on the outer aspect of the 
ankle are stretched or torn. This 
type sprain should be treated vigor- 
ously, particularly during the first 
few days; the more vigorous the im- 
mediate treatment, the less disabil- 
ity results. 




Dr. Cox and "Red" Romo (right), head trainer at Naval Academy, examine injury 



What is the best first-aid? 

The foot should be elevated im- 
mediately and ice should be ap- 
plied. Then the ankle should be 
taped in the neutral position to re- 
approximate the ligaments. Later 
the patient should be encouraged to 
walk with crutches to "pump" the 
edema from the ankle region. The 
worst way to treat an ankle sprain is 
to ignore the injury and allow the 
athlete to "walk it out." If the initial 
injury is not treated properly, there 
may be recurrent sprains and fre- 
quent disability. 

How should ice be applied to 
ankle sprains? 

Immersing the injured ankle in 
ice water immediately after the 
injury is the best method to obtain 
vasoconstriction and discourage 
swelling. Ice packs applied to the 
ankle are also effective. The first 
thing we do for someone at the 
Naval Academy who has sprained 
an ankle is to immerse the ankle in 
an ice whirlpool for 30 minutes. 
Then the ankle is wrapped in tape — 
a compression-type wrap with an 
open front allowing room for swell- 




Properly taped ankle. Note opening in 
front to allow for swelling 

ing is used initially. The patient can 
remove the tape if it becomes too 
tight. We encourage the patient to 
keep the foot elevated and to apply 
an ice pack over the tape as often as 
possible for the first 48 hours. Each 
day the sprained ankle is un- 
wrapped for another whirlpool treat- 
ment. We use the ice-water whirl- 
pool for the first three days and then 



6 



U.S. Navy Medicine 



switch to alternating cold and hot 
whirlpool treatment. This contrast 
bath or "cold-hot" treatment 
causes alternate vasoconstriction 
and vasodilation, which decreases 
edema around the injury. 

What are shin splints? 

That's a catch-all term for various 
stress syndromes of the lower leg. 
For instance, there can be a stress 
fracture of the tibia itself. Pain in 
the anterior or lateral muscle com- 
partments from swelling of the 
muscles can also be called shin 
splints; there is irritation and 
swelling of the muscle fibers, and 
the compartment in the lower leg 
becomes tight and painful. Another 
type of shin splint is a periostitis or 
irritation of the covering of the tibia, 
usually on the anteromedial aspect. 

Another stress syndrome is tendi- 
nitis, or inflammation of the tendons 
that mobilize the foot. The irritation 
usually occurs at the musculoten- 
dinous junction and causes lower 
leg pain which is often called "shin 
splints." 

What's the best overall treatment 
for stress injuries to the foot and 
lower leg? 

The stress that is causing the 
problem must be decreased. If the 
athlete doesn't want to stop all run- 
ning, the pace should be slowed to 
the point where pain ceases. With 
heel pain or longitudinal arch 
strain, pain can be relieved by put- 
ting a piece of soft rubber sponge or 
felt in the heel of the shoe. Also, a 
good supportive running shoe will 
help prevent or alleviate this prob- 
lem. 

In many of these stress syn- 
dromes, the athlete has an imbal- 
ance of the muscles around the foot. 
The most common imbalance is 
tight heel cords. By simply stretch- 
ing the heel cords, many stress syn- 
dromes can be eliminated. This is 
the single most important preven- 
tion and treatment for the condi- 
tions I mentioned previously as shin 
splints. 

Another treatment that will help 
is applying pads to various parts of 




Felt pads help supinate foot and prevent 
shin splints in runners 

the foot. For instance, a small, re- 
shaped felt pad, Vi-inch thick, un- 
der the first metatarsal head and 
along the shaft of the first metatar- 
sal is an excellent way to treat shin 
splint syndromes. The pad supi- 
nates the foot slightly, relieving 
some stress. 

Are oral enzymes effective in 
treating sprains, contusions, and 
other swelling injuries? 

It has not been proven that oral 
enzymes have any effect on swelling 
injuries, so they are not used here 
at the Naval Academy. Most people 
in sports medicine say that if en- 
zymes are used, they should be in- 
jected into the site of injury — but 
this practice is seldom used any 
more. 

Are some people more prone than 
others to stress syndromes of the 
lower leg? 

Yes. If someone not used to 
activity begins to jog at too rapid a 
pace or in too advanced a program, 
he will subject himself to these 
stress syndromes. Well-conditioned 
athletes seldom get the syndromes 
unless there has been a change or 
break in training. 

How can someone condition him- 
self to prevent stress syndromes? 



Heel cord stretching exercises are 
very effective. You stand 12 inches 
from a wall and lean forward, put- 
ting your chest against the wall 
without raising your heels from the 
floor [Figure 1], If this can be done 
easily, the position should be held 
for about ten minutes; as the heel 
cords stretch, less pull is felt and 
the distance from the wall can be in- 
creased. This exercise should be 
done two or three times a day. 

Another way to stretch heel cords 
is to stand for ten minutes with your 
heels on the floor and your forefeet 
on a book approximately four inches 
thick [Figure 2], The more often you 
do this, the greater the benefit. 

It's important for an athlete to 
perform heel cord stretching exer- 
cises after he has sustained an in- 
jury and hasn't been participating 
in athletic activities. If a cast or tape 
has immobilized the foot or ankle, 
the Achilles tendon [heel cord] has 
become tight and needs stretching. 




Another type of effective exercise 
to prevent injury is the "lateral 
step-up." This is a relatively simple 
exercise, but it's excellent for 
strengthening all muscles of the 
lower extremities and trunk. People 
with knee or ankle injuries can use it 
as a means of rehabilitation. It can 
be performed anywhere, so it's ap- 
propriate for the Navy where indi- 
viduals are on different training 
exercises while on duty — at sea, for 
example. 

The step-up exercise is performed 
using a block, 6 inches high, placed 
against a wall so you can't lean and 
decrease the workload on the ex- 
tremity. If such a block is not avail- 
able, this exercise can be performed 



Volume 68, October 1977 



on any stairstep. Place one foot on 
the block and the other foot parallel 
on the floor, with the toes approxi- 
mately at the instep of the foot on 
the block. Using the leg on the 
block, raise your body until full ex- 
tension of that knee is obtained, 
then go back down to the original 
position. Lift off and land on your 
heel to avoid toe push off. 

When first starting lateral step- 
ups, the foot on the floor should be 
approximately 4 inches from the 
foot on the block. As strength in- 
creases, the distance can be ex- 
tended to 12 inches and, if possible, 
the height of the block can be in- 
creased to 12 inches. There's no 
reason to go higher than 12 inches. 

It is important to do this step-up 
exercise for a certain period of time, 
and not for repetitions. The exercise 
is done for three minutes per leg, 
three times a day, and is gradually 
increased to five minutes per leg, 
five or six times a day. 

What type of knee problems are 
athletes likely to develop? 

Other than the stress -related in- 
juries, most knee problems will be 
acute injuries. A common injury oc- 
curs while the athlete's foot is 
planted on the ground and the body 
turns in the opposite direction, re- 
sulting in a twisting force applied to 
the knee. The athlete feels a sudden 
pain, sometimes accompanied by a 
pop or click which could mean injury 
to a knee cartilage, the kneecap, or 
even one of the knee ligaments. The 
immediate first-aid is to minimize 
weight-bearing and apply ice to the 
injury. Ace bandages should not be 
used — they offer little support and 
constrict the knee area, impeding 
the circulation returning from the 
calf. Such knee injuries should be 
evaluated by a physician as soon as 
possible. 

Why do some people hear a 
grinding noise when they do knee- 
bends? 

Grinding or crackling noise com- 
ing from a joint is called crepitus. 
This is caused by a portion of one 
bone moving on another bone. In 




Trainer HM2 Ross Langston demon- 
strates lateral step-up exercise 



most cases, crepitus is normal — like 
cracking your knuckles. It's signifi- 
cant only when it's painful, which 
may mean there is irritation be- 
tween the bony surfaces. This is 
most common between the kneecap 
and the femoral condyles behind the 
kneecap. 

Patellar or kneecap pain often oc- 
curs when a person is going up and 
down stairs or ladders, or running 
up and down hills. People who have 
such pain should avoid stairs, and 




Dr. Cox demonstrates neck examination 



run on soft surfaces and level 
ground. Incidentally, running down- 
hill causes many more stresses than 
running uphill. 

Why are hamstring muscle pulls 
so common? 

The hamstrings are decelerators 
of the legs, so a hamstring muscle 
may be torn when someone is 
running fast or sprinting and over- 
stretches these powerful muscles. 
The important thing to remember 
when any muscle is torn is that heal- 
ing time cannot be hurried. 

Treatment is aimed at decreasing 
the inflammatory reaction around 
the muscle by applying ice packs for 
the first two or three days after the 
injury. Then ice massage is started. 
A paper cup filled with water is put 
in the freezer to harden into an ice- 
block. The patient can take this ice- 
block from the freezer, peel off 
some of the paper, and massage the 
injured muscle area. We encourage 
the patient to stretch the torn mus- 
cle very gently while using the ice. 
The ice helps in two ways: it de- 
creases the inflammation and it 
numbs the area so the injured mus- 
cle can be stretched and allowed to 
heal in this stretched position. If 
someone walks around with the 
knee flexed, the muscle will heal in 
a shortened position and is prone to 
reinjury as soon as hard running is 
attempted. When ice massage and 
stretching are used, the muscle 
takes the same time to heal but it 
heals in the elongated position and 
will seldom be reinjured. After the 
muscle has completely healed, the 
patient should do several flexibility 
exercises and gradually work back 
into a training program so other 
muscles are not injured. 

Is this same treatment good for 
pulled groin muscles? 

Yes. Muscle pulls around the 
groin usually involve the hip flexors 
or hip adductors. These injuries also 
respond well to ice and limited 
activity. Again, it's important for 
the patient to perform flexibility 
exercises before getting back into 
full training. 



U.S. Navy Medicine 




Dr. Cox treats shoulder dislocation. Trainer assists by applying countertraction 



In contact sports, we often hear 
about "hip pointer" injuries. What 
are they? 

This is a common name for a con- 
tusion directly over the iliac crest. 
This area is very vulnerable to 
direct trauma because the iliac crest 
is close to the skin and has little 
natural padding. A direct blow can 
injure the subcutaneous tissue as 
well as the muscle attachments. Al- 
though not serious, this is a very 
painful injury. It responds well to 
ice and limited activity. 

What other contusions occur in 
athletics, and what are the dangers? 

A contusion of the thigh muscula- 
ture occurs from a direct blow to the 
front of the thigh. The injury results 
when the anterior thigh strikes 
another object with considerable 
force. There is usually immediate 
pain and swelling in the area, and 
often a large hematoma forms as a 
result of bleeding into the muscle. 
As with other muscle injuries, if this 
injury is not treated properly the 
thigh will be prone to reinjury. 

The hematoma occasionally be- 
comes calcified. This condition is 



called myositis ossificans and can 
be very disabling because of limited 
range of motion of the knee. To pre- 
vent this problem, a thigh contusion 
should be treated as soon as possi- 
ble with ice to decrease bleeding 
and swelling. The patient should 
avoid flexing the knee for the first 
48 hours to prevent further tearing 
or damage to the muscle. Heat 
should never be applied to a thigh 
contusion during the first five days. 

How does a shoulder dislocation 
occur and what is the best way to 
treat this injury? 

This is a common injury, usually 
caused by a stress that forces the 
arm upward and backward. The 
most common type of shoulder dis- 
location is an anterior-inferior dis- 
location, which is accompanied by 
tremendous pain and spasm in the 
shoulder muscles. 

To reduce the dislocation, the pa- 
tient must relax. We seldom use 
narcotics at the Naval Academy, but 
we have found that a 10 mg injec- 
tion of Valium, given intramuscular- 
ly or preferably intravenously, will 
afford sufficient relaxation to reduce 



a dislocation in even the most 
muscular individual. 

The simplest way to reduce a dis- 
located shoulder after the injection 
is to pull the arm straight out from 
the body. While an assistant holds 
the patient flat on the table, traction 
is applied in the longitudinal direc- 
tion. As the patient relaxes, the arm 
is gradually abducted to the 90° 
position and then slightly higher. 
Usually as this position is reached, 
the head of the humerus will slide 
back into place. 

Another way to reduce this dis- 
location is to place a foot in the pa- 
tient's armpit and apply traction in 
the longitudinal direction. Again, 
an assistant can apply countertrac- 
tion. In this reduction the foot 
serves as a fulcrum, allowing the 
head of the humerus to gently slip 
back into the socket. The reduction 
should be gentle, without applica- 
tion of force, to avoid fracturing a 
bone. Independent duty corpsmen 
should try to reduce such injuries if 
there is no evidence of a fracture, 
because shoulder dislocations are 
acutely painful and it may be some 
time before the services of a physi- 
cian can be obtained. 

Another common injury to the 
shoulder in sports is a "shoulder 
separation." This injury to the 
acromioclavicular joint can occur if 
an athlete falls directly on the point 
of the shoulder. The pain is located 
directly over the acromioclavicular 
joint, and may be accompanied by a 
marked upward prominence of the 
distal clavicle. The only treatment 
necessary for this injury is immo- 
bilizing the arm in a sling for com- 
fort and administering analgesics 
for pain. There is no urgency in 
locating a physician because only 
the third-degree or complete dis- 
location is sometimes treated surgi- 
cally. 

What about bursitis of the shoul- 
der? 

We seldom see an actual bursitis 
in athletes. True bursitis is the in- 
flammation of a small sac between 
the rotator cuff and the acromial 
process of the scapula. The more 



Volume 68, October 1977 



common shoulder condition — some- 
times called "bursitis" — is actually 
a tendinitis of one of the several 
tendons of the rotator cuff. This 
condition is aggravated by abduc- 
tion of the arm. When the arm is 
raised, the rotator cuff tendons are 
brought under the acromial liga- 
ment, which is a thick band that can 
impinge on the tendon and cause 
the inflammation. 

To cure this type of tendinitis, the 
patient must avoid abduction of the 
shoulder joint. Sometimes, to see if 
the tendinitis is improving, the pa- 
tient will move his arm in circles. 
This further irritates the tendon. 
The patient should be told that the 
tendinitis will last at least seven 
days and that the arm should not be 
raised until the tendon heals. Often 
this limitation of movement, aided 
by a sling, will get rid of the prob- 
lem. If the condition persists, the 
patient should see a physician. 

Would you discuss "tennis el- 
bow"? 

Tennis elbow is an inflammation 
that occurs on the medial or lateral 
epicondyle of the humerus. The 
common form is on the lateral 
epicondyle at the origin of the ex- 
tensor muscles of the forearm. The 
problem is caused by overexertion 
of these extensor muscles; tender- 
ness is found directly on the point of 
the outside elbow. Medial epi- 
condylitis results from an irritation 
at the origin of the flexor muscles of 
the forearm; its point of tenderness 
is on the medial point of the elbow. 
Both types of tennis elbow are com- 
monly seen in racket sports, throw- 
ing sports, and even in bowling. 

Once again, the condition is 
treated by decreasing the patient's 
activity and applying ice. A com- 
mercially available elastic strap that 
fits around the forearm decreases 
mechanical pressure on the origin of 
the muscles and helps alleviate the 
problem. A physician can give oral 
anti-inflammatory medications to 
speed healing. 

These elbow problems are seldom 
seen in athletes younger than 25. As 
tennis players become older, they 



have decreased speed and reflexes. 
More forearm and wrist motion is 
used in the swing of the racket to 
compensate for poor body position 
and more stress is applied to the 
muscle origins at the elbow. 

What about finger and thumb in- 
juries? 

An athlete will often dislocate one 
of the finger joints in many sports 
activities. The proximal interpha- 
langeal joint is most frequently dis- 
located. When this happens, you 
can see a marked deformity of the 
finger. Traction applied in a longi- 
tudinal direction will usually reduce 
the dislocation. It's my opinion that 
after any such injury X-rays should 
be taken to rule out chip fracture or 



a combined fracture dislocation. 
These injuries should then be evalu- 
ated by a physician. 

You haven't mentioned heat as 
a treatment for sports-related in- 
juries. 

It's an old wives' tale that we 
treat acute injuries with heat. All 
injuries should initially be treated 
with ice. One thing for which heat is 
used is an infectious type process 
such as an abscess or cellulitis. 
Heat may also be used to alleviate 
muscle spasms caused by strains of 
the neck or shoulder muscles. But if 
the spasms result from an acute in- 
jury, such as a pulled or contused 
muscle, ice should be used for the 
first 48 hours before heat is applied. 



More About Sports Medicine 

Want to know more about sports medicine? Here are some re- 
sources you may find useful: 

• "Medical Evaluation of the Athlete ... A Guide," published by the 
American Medical Association, is aimed at physicians who care for 
athletes. Topics covered include proper conditioning, good coaching, 
capable officiating at sports activities, proper equipment and facili- 
ties, and adequate health supervision. There is a detailed description 
of how to do a complete health checkup on athletes, a chart of condi- 
tions that disqualify a person from participating in sports, and a post- 
er describing first aid for sports injuries. The booklet costs 80^ and 
can be obtained from the Order Department OP-209, American Medi- 
cal Association, 535 North Dearborn Street, Chicago, Illinois 60610. 

Also available from the Order Department are several other AMA 
publications on recent developments in sports medicine. Ask for a 
list. 

• The National Registry for Football Head and Neck Injuries, estab- 
lished by Temple University School of Medicine in Philadelphia, col- 
lects data on serious football injuries. The information is offered to 
athletic associations and other interested groups to support rule 
changes that would protect the head and spinal column from undue 
abuse in football games. 

• Lenox Hill Hospital in New York City runs an Institute of Sports 
Medicine and Athletic Trauma, headed by James A. Nicholas, M.D. 
An interview with Dr. Nicholas published in U.S. News and World 
Report (29 December 1975) contains useful information on sports in- 
juries. 

• Several medical problems related to athletics are discussed in a 
special Olympic Games issue of the Journal of the Americal Medical 
Association published 12 July 1976. This issue has articles on en- 
larged hearts in distance runners, gaining and losing weight, health 
care for women athletes, and exercise-induced asthma. 



10 



U.S. Navy Medicine 



NOTES 



ROSTER - 1 SEPTEMBER 1977 



The following is a list of staff medical and denial officers of major fleets and 
forces, district medical arid dental officers, commanding officers, executive offi- 
cers, directors of administrative services, directors of clinical services, chief nurses 
of Medical Department activities, and division surgeons and dental officers of 
Marine divisions. Marine aircraft wings and Marine brigades. 



CINCPACFLT/CINCPAC RADM G.E. GORSUCH, MC, USN (ADDU) 

C1NCPACFLT CAPT R.W. BRUCE, DC, USN (ADDU) 

AOCAPTJ. WOLF, MSC, USN 

C1NCLANT/CINCLANTFLT/ SACLANT 

(COMTRALANT) RADM E.P. RUCCI, MC, USN 

CINCLANT/CINCLANTFLT/C1NCWESTLANT RADM G. A. BESBEKOS, DC, USN (ADDU) 

CINCLANTFLT AO CDR W. BRANSCUM. MSC, USN 

SACLANT AO CDR W.I. CASLER, MSC, USN 

C1NCUSNAVEUR CAPT H.E. SHUTE, MC, USN (ADDU) 

CAPT R.S. NOLF, DC, USN (ADDU) 

COMNAVFOR JAPAN CAPT B.L. JOHNSON, MC, USN (ADDU) 

CAPT E.T. WITTE, DC, USN (ADDU) 

COMNAVLOGISTICS RADMG.E. GORSUCH, MC. USN 

AO LCDR J. WILSON, MSC, USN 

COMNAVA1RLANT CAPT R.P. CAUDILL. MC, USN 

CAPT S.W. PERAND, DC, USN (ADDU) 

COMNAVAIRPAC CAPT K.H. REICHARDT, MC, USN 

CAPT J.E. HYDE, DC, USN (ADDU) 
AO LCDR C. SCHMUTZ, MSC, USN 

COMSUBLANT CAPT B.J. BLANKENSHIP, MC, USN 

COMSUBPAC CAPTR.T. LARSEN, MC, USN 

CAPT R.W. BRUCE, DC, USN (ADDU) 

CNET (NAS PENSACOLA, FLA) RADM R.L. BAKER, MC, USN (ADDU) 

CAPT J.W. PENTECOST, DC, USN (ADDU) 
AO CAPT S.D. BARKER. MSC, USN (ADDU) 

CNATECHTRA (NAS MEMPHIS, TENN) CAPT C.W. BRAMLETT, MC, USN (ADDU) 

CAPT D.G. GARUER, DC, USN (ADDU) 
AO LCDR W.F. BENEDICT, MSC, USN 

CNAT (NAS CORPUS CHRIST1, TEX) CAPT J. R. LUKAS, MC, USN (ADDU) 

COMNAVSURFLANT CAPT W.M. PHILLIPS, MC, USN 

CAPT J.C. KELLY, JR., DC. USN (ADDU) 

COMNAVSUSFPAC CAPT J.W. JOHNSON. MC, USN 

CAPT G.L. BARBOR, DC, USN (ADDU) 
AO LCDR B.L. OZMENT, MSC, USN 

COMNAVFORCARIB/COM ANTILLES DEF COMD , . . CAPT W.J. WAGNER, MC, USN (ADDU) 

CAPTD.E. BARLOW, DC, USN (ADDU) 

COMFAiRMED CAPT R.D. CULLOM, DC, USN (ADDU) 

COMICEDEFOR CAPT M.C. CLEGG, DC, USN (ADDU) 

COMTRAWING 4 CAPT J.A. MCKINNON, JR., DC, USN (ADDU) 

OPNAV CAPTC.A. BROWN, DC, USN (ADDU) 

OFFNAVRESCH, WASHINGTON, DC CAPT J.F. KELLY, DC, USN (ADDU) 



FIRST NAVAL DISTRICT 

NAVREGMEDCL1NIC, PORTSMOUTH, NH . 
NAVREGMEDCEN, NEWPORT, RI 



NAVREGDENCEN. NEWPORT, RI . 



THIRD NAVAL DISTRICT . 



NAVAL SUBMARINE MEDICAL CENTER, NEW 
LONDON, CONN 



NAVAL SUBMARINE MEDICAL RESEARCH 
LABORATORY, GROTON, CONN 



, DMO CAPT V.L. STOTKA, MC, USN (ADDU) 
DDO CAPT C.J. SCHULTZ, JR., DC, USN (ACTING) 
AO LCDRR.E. SMITH, MSC, USN 

. CO CDR D.E. REEVES, MSC, USN 
XO LCDR D. MCDERMOTT, MSC. USN 
SR NURSE CDR M. CROCKETT, NC, USN 
CO CAPT V.L. STOTKA, MC, USN 
DCS CAPT W,L. WILLIAMS, MC, USN 
DAS CDR F. RICHARDSON, MSC, USN 
CH NURSE CAPT L. ROBINSON, NC, USN 

. CO CAPT C.J, SCHULTZ, JR., DC, USN (ACTING) 
DCS CAPT C.J. SCHULTZ, JR., DC, USN 
DAS LT J.C. WANAMAKER, MSC, USN 



DMO CAPTL.H. SEA TON, MC, USN (ADDU) 
DDO CAPTE.M, PENNELL, JR., DC, USN (ADDU) 
AO LT W.C. EICHELBERG, MSC, USN (ADDU) 

CO CAPT L.H. SEATON, MC. USN 
DCS CAPT G.E. GRIFFIN III , MC , USN 
DAS CDRF.G. ANDERSON, JR., MSC, USN 
CH NURSE CAPT A, BARKER, NC, USN 

COCAPTR.L. SPHAR, MC, USN 



FOURTH NAVA1 DISTRICT 

NAVREGMEDCEN, PHILADELPHIA, PA . 



NAVREGDENCEN, PHILADELPHIA, PA . 



NAVAL MEDICAL MATERIEL SUPPORT 
COMMAND, PHILADELPHIA, PA 



FIFTH NAVAL DISTRICT . 



NAVREGMEDCEN, PORTSMOUTH, VA . 



NAVREGDENCEN, NORFOLK, VA . 



NAVAL BASE, NORFOLK. VA 

NAVAL OPHTHALMIC SUPPORT & TRAINING 
ACTIVITY, WILLIAMSBURG, VA 



NAVHOSP, CHERRY POINT, NC 

NAVREGMEDCEN, CAMP LFJEUNE, NC . 

NAVREGDENCEN, CAMPLEJEUNE, NC . 



NAVAL ENVIRONMENTAL AND PREVENTIVE 
MEDICINE UNIT NO. 2, NORFOLK, VA 



DMO CAPT R.A. BAKER, MC. USN (ADDU) 

DDOCAPTJ.H. SCRIBNER, DC, USN (ADDU) 

CO CAPT R,A. BAKER, MC, USN 

DCS CAPT J.W. HAYES, MC, USN 

DAS CAPT H.S. RUDOLPH, MSC, USN 

CH NURSE CAPT A. FOLEY, NC, USN 

CO CAPT J.H. SCRIBNER, DC, USN 

DCS CAPT H.E. FREEBURN, JR., DC, USN 

DAS LT D.C. DUNKLEMAN, MSC, USN 

. CO CAPTO. STALLINGS, MSC, USN 
XO CDRR.E. STOCKMAN, MSC, USN 



DMO RADM W.J. JACOBY, JR., MC, USN (ADDU) 
DIR DENACTYS RADM G.A. BESBEKOS, DC, USN 

(ADDU) 
AO LCDR R.M. CURRAN, MSC, USN (ADDU) 
CO RADM W J. JACOBY, JR. , MC , USN 
DCS CAPT C.R. BEMILLER. MC, USN 
DAS CAPT D.E. SHULER, MSC, USN 
CH NURSE CAPT M.P. BRENNAN, NC. USN 
CO RADM G.A. BESBEKOS, DC, USN 
DCS CAPT W.E. QUILTEH, JR., DC, USN 
DAS CDR J.J. KEHOE, JR., MSC, USN 
RADM G.A. BESBEKOS, DC, USN (ADDU) 

CO CAPT M.J. TESTA, MSC, USN 
XO CAPT J. G. WILCOX, MSC, USN 
CO CAPT H.H. COULSON. MSC, USN 
DAS CDR M.L. COOPER, MSC, USN 
CH NURSE CDR E. CARSON, NC, USN 
. CO CAPT J.L. HUGHES, MC, USN 
DCS CAPT R.J. SEELEY, MC, USN 
DASCDRC.A. MCFEE, MSC, USN 
CH NURSE CAPT T. PROTO, NC, USN 
CO CAPT N.K. LUTHER, DC, USN 
DCS CAPT T.L. WHATLEY, DC, USN 
DAS LCDR D.L. WENR1CK, MSC, USN 

OIC CAPT H.J. CANDELA, MC, USN 
AO LT J.M. MOODY, MSC, USN 



CAIRO, EGYPT 

U.S. NAVAL MEDICAL RESEARCH UNIT NO. 3 . 



TAIWAN 

U.S. NAVHOSP. TAIPEI, 



U.S. NAVAL MEDICAL RESEARCH UNIT NO. 2, 
TAIPEI 



PHILIPPINES 

U.S. NAVREGMEDCEN, SUBICBAY . 



U.S. NAVREGDENCEN, SUBICBAY . 



SPAIN 

U.S. NAVREGMEDCEN, ROTA . 



COMNAVACT, SPAIN . 



CO CAPT R.H. WATTEN, MC, USN 

AO LT D.L. WHEELER, MSC, USN 

SR NURSE CDR M.J. NELSON, NC, USN 



CO CAPT S.H. LING, MC, USN 

DASCDRK.L.DARR, MSC, USN 

CH NURSE CDR J. PORTER, NC, USN 

CO CDR K. SORENSEN, MC, USN 
AO LCDR S.A. NESS, MSC, USN 



CO CAPT EX. BINGHAM, MC. USN 
DASCDRC.W. EMMA, MSC, USN 
CH NURSE CDR E. O'NEILL, NC, USN 

CO CAPT M.M. STEVENS. DC, USN 
DCS CAPT R.P. HUESTIS, DC, USN 
DAS LT N.E. CARROLL, MSC, USN 



CO CAPT J. E. WILSON, MC, USN 

DAS CDR R.A. MORIN, MSC, USN 

CH NURSE CDR H. HOLBROOK, NC, USN 

CAPT G.B. CROSSMIRE, DC, USN (ADDU) 



HEADQUARTERS MARINE CORPS AND FLEET MARINE FORCE 

HEADQUARTERS, U.S. MARINE CORPS CAPT D.R. HAULER, MC, USN 

CAPT F.R. RULIFFSON. DC, USN 
AOCDRG.S. HARRIS, MSC, USN 

HEADQUARTERS, FMF ATLANTIC CAPT R.R. PALUMBO. MC, USN 

FORDO CAPT M.C. KOHLER, DC, USN 
AOLCDRR.F. COXE, MSC, USN 

SECOND MARINE DIVISION SURGEON CAPT D.W. MARSH, MC, USN 

SECOND FORCE SERVICE SUPPORT GROUP SECOND DENCO CAPT R.A. GASTON, DC, USN 

22ND DENCO FORTRPS CAPT R. DAVIDSON, DC, USN 
AOLCDR P.R. MILL1KEN, MSC, USN 

SECOND MARINE AIRCRAFT WING CAPT E.L. GEHRY, MC, USN 

SECOND FORCE SERVICE SUPPORT GROUP 12TH DENCO CAPT D.T, FENNER, JR., DC. USN 

AO LT J.L. JOHNSON, MSC, USN 
HEADQUARTERS, FMF PACIFIC CAPT B.C. JOHNSON, MC, USN 

FORDO CAPTT.C. ENGER. DC. USN 

AO CAPT L.W. GAY, MSC, USN 

FIRST MARINE DIVISION CDR R.C. HODGES, MSC, USN 

FIRST FORCE SERVICE SUPPORT GROUP FIRST DENCO CAPT B.F. KRESL, DC, USN 

AO LCDR J .A. HELLEY, MSC, USN 

FIRST MARINE AIRCRAFT WING CAPT F.E. DULLY, MC, USN 

THIRD FORCE SERVICE SUPPORT GROUP (DETA) . . 11TH DENCO CAPT R.E. WILLIAMS, JR., DC, USN 

AO LCDR C.A. KELLEY, MSC, USN 
FIRST MARINE BRIGADE CDR M.O. ABBOTT, MC, USN 

21ST DENCO CAPTL.M. MULDROW, JR.. DC, USN 

AOLCDR W.M. MCCLANNAHAN, MSC, USN 

THIRD MARINE DIVISION SURGEON CAPTR.W. JONES, MC, USN 

THIRD FORCE SERVICE SUPPORT GROUP THIRD DENCO CAPT A.F. REID, DC. USN 

AO LCDR T.J. BUFANO, MSC, USN 

THIRD MARINE AIRCRAFT WING CAPT G.E. BALYEAT, MC, USN 

FIRST FORCE SERVICE SUPPORT GROUP 13TH DENCO CAPT J. G. CHUDZINSKI, DC, USN 

AOLCDR M. 1CZK0WSK1, MSC, USN 
FIELD MEDICAL SERVICE SCHOOL, 

CAMP PENDLETON, CALIF CO CAPT W.H. JONES, MSC, USN 

XO CDR E.N. CONDON, MSC, USN 
FIELD MEDICAL SERVICE SCHOOL, 

CAMP LEJEUNE, NC 



CO CAPT E.J. STEWARD, MSC, USN 
XO CDR J.M, CORRELL, MSC, USN 



-This roster was prepared by BUMED Code 312. 



NATIONAL NAVAL MEDICAL CENTER, 
BETHESDA, MD 



NATIONAL NAVAL DENTAL CENTER, 
BETHESDA, MD 



NAVAL HEALTH SCIENCES EDUCATION AND 
TRAINING COMMAND, NNMC, 

BETHESDA, MD 



NAVAL SCHOOL OF HEALTH CARE 
ADMINISTRATION, BETHESDA, MD . 



NAVAL MEDICAL RESEARCH INSTITUTE, 
BETHESDA, MD 



NAVAL MEDICAL RESEARCH AND 
DEVELOPMENT COMMAND, BETHESDA, MD . 

ARMED FORCES INSTITUTE OF PATHOLOGY, 
WASHINGTON, DC 

ARMED FORCES RADI0B10L0GY RESEARCH 
INSTITUTE, BETHESDA, MD 



CO RADM J.T. HORGAN, MC, USN 

DCS CAPTQ.E. CREWS, JR., MC, USN 

DAS CAPT H.P. MILLER, MSC, USN 

CH NURSE CAPT H. FURMANCHIK, NC, USN 

CO CAPT S.T. ELDER, DC, USN 

DCS CAPT A.E. SORENSON, DC, USN 

DAS CDR P.T, RAY, MSC, USN 



CO CAPT S. BARCHET, MC, USN 
XO CAPT D.M. ALLMAN, DC, USN 
AO CDR D.R. CRAIG, MSC, USN 

CO CAPT E. A. BRYANT, JR., MSC, USN 
XO CDR P. COLLIER, MSC, USN 

CO CAPT W.F. MINER, MC, USN 
AO CDR M.L. FITTS, MSC, USN 

CO CAPT J.D. BLOOM, MC, USN 

EXEC ASST CDR W. SCHROEDER, MSC , USN 

DIR CAPT E.C. COW ART, JR. , MC, USN 

. DIR COL D.W. MCINDOE, MC, USAF 
AOLCDRP.H. MOORE, MSC, USN 



NAVAL MEDICAL DATA SERVICES CENTER, 
BETHESDA, MD 



NAVHOSP, PATUXENT RIVER, MD . 



NAVHOSP, QUANTICO, VA . 



ITALY 

U.S. NAVREGMEDCEN, NAPLES . 



U.S. NAVREGDENCEN, NAPLES . 



U.S. NAVAL ENVIRONMENTAL AND PREVENTIVE 
MEDICINE UNIT NO. 7, NAPLES 



JAPAN 

U.S. NAVREGMEDCEN, YOKOSUKA . 



U.S. NAVREGDENCEN, YOKOSUKA , 
U.S. NAVREGMEDCEN, OKINAWA . . 



MARIANA ISLANDS 

U.S. NAVREGMEDCEN, GUAM . 



U.S. NAVREGDENCEN, GUAM . 
COMNAVMARIANAS 



CO CDR J.R. KNIGHT, MSC, USN 
XO LCDR F.G. ANDERSON, MSC. USN 
. CO CDR J.R, ERIE, MSC, USN 
DAS CDR E.R. CHRISTIAN, MSC, USN 
CH NURSE CAPT D.H. HOOKER, NC, USN 
COCAPTR.F, SCHINDELE, MSC, USN 
DCS CAPT I.C. MAZZARELLA, MC, USN 
DASCDRR.B. HINDS, MSC, USN 
CH NURSE CDR M.F. HALL, NC, USN 



CO CAPT N.W. COOLEY, MC, USN 
DCS CAPT J.V. SHARP, MC, USN 
DAS CDR J.J. STEIL, MSC, USN 
CH NURSE CAPT C. SHEA, NC, USN 
. CO CAPT R.D. CULLOM, DC, USN 
DCS CAPT J.T. JANUS, DC, USN 
DASCDRR.S. SKELLY, MSC, USN 

. OIC CAPT R.L. MARLOR, MC, USN 
AO LCDR J.F. CONNOLLY, MSC, USN 

CO CAPT EX. JOHNSON, MC, USN 

DAS LCDRT.E. THOMAS, MSC, USN 

CH NURSE CAPTD. CORNELIUS, NC, USN 

CO CAPT E.T. WITTE, DC, USN 

DCS CAPTR.E. HOWE, DC, USN 

DAS LCDR E. P1ERSOL, MSC, USN 

CO CAPT C.S. LAMBDIN, MC, USN 

DCS (VACANT) 

DAS CDR C. MOORE, MSC, USN 

CH NURSE CAPT M. CONLEY, NC, USN 

. CO CAPT I.J. WOODSTEIN, MC, USN 
DCS CAPT R.G. SABLAN, MC, USN 
DAS CDR E.J. HATCH, MSC, USN 
CH NURSE CDR M. KELLY, NC, USN 
CO CAPT P.R. FALCONE, DC, USN 
DCS CAPT G.A. SHORT, DC, USN 
DAS LT O.H. GRISHAM, MSC, USN 
CAPT P.R. FALCONE, DC, USN (ADDU) 



SIXTH NAVAL DISTRICT . 



NAVREGMEDCEN, CHARLESTON, SC . 



NAVREGDENCEN, CHARLESTON, SC . 



NAVAL BASE. CHARLESTON, SC . 
NAVHOSP, BEAUFORT, SC 



NAVREGDENCEN, PARRIS ISLAND, SC . . . 
NAVREGMEDCEN, JACKSONVILLE, FLA . 

NAVREGDENCEN, JACKSONVILLE, FLA . 
NAVHOSP, KEY WEST, FLA 



NAVREGMEDCEN, MEMPHIS, MILLINGTON, 
TENN 



NAVREGMEDCEN, ORLANDO, FLA . 



NAVREGDENCEN, ORLANDO, FLA . 



NAVAL AEROSPACE AND REGIONAL MEDICAL 
CENTER, PENSACOLA, FLA 



NAVREGDENCEN, PENSACOLA, FLA . 



NAVAL AEROSPACE MEDICAL RESEARCH 
LABORATORY, PENSACOLA, FLA 

NAVAL AEROSPACE MEDICAL INSTITUTE, 
PENSACOLA, FLA 



NAVAL DISEASE VECTOR ECOLOGY AND 
CONTROL CENTER, JACKSONVILLE, FLA . 



EIGHTH NAVAL DISTRICT 

NAVREGMEDCEN, CORPUS CHRISTI, TEX . 



NAVREGMEDCEN, NEW ORLEANS, LA . 



DMO CAPT E.B. MCMAHON, MC, USN (ADDU) 
DDO CAPT R.G. GRANGER, DC, USN (ADDU) 
AO LCDR R.K. GREEN, MSC, USN (ADDU) 
. CO CAPT E.B. MCMAHON, MC, USN 
DCS CAPTR.E. TOBEY, MC. USN 
DAS CDR G.M. ELLIS, MSC, USN 
CH NURSE CAPT R. PAMPUSH, NC, USN 

CO CAPT R.G, GRANGER, DC, USN 
DCS CAPT W.P. KELLY, DC, USN 
DAS LCDR L.T. FOSKEY, MSC, USN 
CAPT R.G. GRANGER, DC, USN (ADDU) 

. CO CAPT D.C. GOOD, MC, USN 
DCS CAPT W.R. MULLINS, MC, USN 
DAS CDR W. BLANKENSHIP, MSC, USN 
CH NURSE CAPT B. SLATER. NC, USN 
CO CAPT H.J. SAZIMA, JR., DC, USN 
DCS CAPT A. HERR, DC, USN 
DAS LCDR L.R. MAASSEN, MSC, USN 

CO CAPT M, MUSELES, MC, USN 
DCS CAPT N.R. RAFFAELLY, MC, USN 
DAS CAPT L.J. SCHAFFNER, MSC, USN 
CH NURSE CAPT M.J. WALKER, NC, USN 
. CO CAPT E.E. MCDONALD, JR., DC, USN 
DCS CAPT E.H. PLUMP, DC , USN 
DAS LCDR M.J. KERN, MSC, USN 
CO CAPT P.F. WELLS II, MC, USN 
DAS LCDR F.D. R.FISHER, MSC, USN 
CH NURSE CAPTD. DUNN, NC, USN 

CO CAPT C.W. BRAMIETT, MC, USN 
DCS CAPTG.C. BnSGHAM, MC, USN 
DAS CDRF.E. BENNETT, MSC, USN 
CH NURSE CAPT M. MAYNARD, NC, USN 
CO CAPT A.L. POWELL HI, MC, USN 
DCS CAPT N.S. NURED1NI, MC, USN 
DASCDRL.H. TURBIVILLE, MSC, USN 
CH NURSE CAPT J.M. REDGATE, NC. USN 
CO CAPTH.C. PUND, JR., DC, USN 
DCS CAPT H.S. SAMUELS, DC, USN 
DAS LCDR P.N. ACKLEY, MSC, USN 

CO RADM R.L. BAKER, MC, USN 
DCS CAPT M.C. CARVER, MC, USN 
DAS CAPT S.D. BARKER, MSC, USN 
CH NURSE CAPT K. WILSON, NC, USN 
CO CAPT J.W. PENTECOST, DC, USN 
DCS CAPT S.E. PEPEK, DC, USN 
DAS LCDR J.H. SMITH, MSC, USN 

. CO CAPT R.E. MITCHEL, MC, USN 

. CO CAPT H.S. TROSTLE, MC, USN 
XO CDRT.F. LEVANDOWSKI, MSC, USN 

OIC CDR S.A. WHITE, MSC, USN 
AOLT B.R. FORO, MSC, USN 



. DMO CAPT P.C. GREGG, MC, USN (ADDU) 
DDO CAPTE.L. HOFFIUS, DC, USN (ADDU) 
CO CAPT J.R. LUKAS, MC, USN 
DCS CAPT D.W. PEACE, JR. , MC, USN 
DAS CDRG.W. BALDAUF, MSC, USN 
CH NURSE CAPT M. DONOGHUE, NC, USN 

. CO CAPT P.C. GREGG, MC, USN 
DCS CAPT R.A. GRENIER, MC, USN 
DAS CDR J.L.GRAVES, MSC, USN 
CH NURSE CAPT B. NAGY, NC, USN 



NINTH NAVAL DISTRICT 

NAVREGMEDCEN. GREAT LAKES, ILL . 

NAVREGDENCEN, GREAT LAKES, ILL. 



NAVAL DENTAL RESEARCH INSTITUTE, 
NAVAL BASE, GREATLAKES, ILL 



DMO CAPT M.J. VALASKE, MC, USN (ADDU) 
DIR DENACTYS CAPT C.J. MCLEOD, DC, USN (ADDU) 
AO LT R.L. BERKLEY, MSC, USN 
CO CAPT M.J. VALASKE, MC, USN 
DCS CAPT L.R. FOUT, MC. USN 
DAS CDR R.W. TANDY, JR., MSC, USN 
CH NURSE CAPT E.M. PFEFFER, NC, USN 
. CO CAPT C.J. MCLEOD, DC. USN 
DCS CAPT R.D. PRINCE, DC, USN 
DAS CDR M.K. LAW, MSC, USN 

. COCAPT M.R. WIRTHLIN, JR., DC, USN 



NAVAL HOSPITAL CORPS SCHOOL, 
GREAT LAKES, ILL 



NAVAL ENVIRONMENTAL HEALTH CENTER, 
CINCINNATI, OHIO 



TENTH NAVAL DISTRICT 

NAVHOSP, GUANTANAMO BAY, CUBA . 



COMNAVBASE, GUANTANAMO BAY, CUBA . 
NAVHOSP, ROOSEVELT ROADS, PR 



NAVREGDENCEN, ROOSEVELT ROADS, PR . 



. COCDRV.A. SWINDALL, MSC, USN 
XO LCDRF. BRIAND. MSC, USN 
SR NURSE CDR P. FLEURY, NC. USN 

. OIC CAPT T.N. MARKHAM, MC, USN 
MED ADM OFF LT R.L. WILLIAMSON, MSC, USN 



DMO CAPT W.J. WAGNER, MC, USN (ADDU) 
DDO CAPT D.E. BARLOW, DC, USN (ADDU) 
CO CAPT T.J. TRUMBLE, MC. USN 
DASLCDR R, RELINSKI, MSC, USN 
CH NURSE CDR S. MERRIL, NC, USN 

. DO CAPT J.R. BOHACEK, DC, USN (ADDU) 

CO CAPT W.J. WAGNER, MC, USN 
DAS CDR J. DEWITT, MSC, USN 
CH NURSE CAPT C. FINN, NC, USN 
COCAPT D.E, BARLOW, DC, USN 
DCS CAPT R.A. MURPHY, DC, USN 
DAS LCDR L.R. MOCK, MSC, USN 



ELEVENTH NAVAL DISTRICT . . 



NAVREGMEDCEN, CAMP PENDLETON, CALIF . 

NAVREGDENCEN, CAMP PENDLETON, CALIF . 
NAVREGMEDCEN, LONG BEACH, CALIF 



NAVREGDENCEN, LONG BEACH. CALIF - 



NAVAL SCHOOL OF HEALTH SCIENCES, 
SAN DIEGO, CALIF 



NAVAL ENVIRONMENTAL AND PREVENTIVE 
MEDICINE UNIT NO. 5, SAN DIEGO, CALIF . . 



NAVHOSP, PORT HUENEME, CALIF . . . 
NAVREGMEDCEN, SAN DIEGO, CALIF . 



DMO RADM D.E. BROWN. JR.. MC. USN (ADDU) 
DIR DENACTYS RADM W.L. DARNALL, JR., DC, USN 

(ADDU) 
AO CDR J.B. KNIGHT, MSC. USN (ADDU) 
COCAPTC.H. LOWERY, MC, USN 
DCS CAPT D. REID. MC, USN 
DAS CAPT F.C. PITTINGTON, MSC, USN 
CH NURSE CAPT P. PORTZ, NC, USN 
CO CAPT B.C. SHARP. DC. USN 
DCS CAPT J. D. MAHONEY, DC, USN 
DASLCDR J.D. GALBREATH, MSC, USN 
CO CAPT R.M. LEHMAN, MC, USN 
DCS CAPT J.A. ZIMBLE, MC, USN 
DAS LCDR D.N, BENANDER. MSC, USN 
CH NURSE CAPT A. WILLIAMS, NC, USN 
. CO CAPT H.W. HODSON. DC, USN 
DCS CAPT F. A. PAPERA, DC, USN 
DAS LCDR A.E. KENNEDY, MSC, USN 

CO CAPT W.E. MCC0NV1LLE, MSC, USN 
XO CDR G.E. HAMMETT, MSC, USN 
SR NURSE CAPT M. PERLOW, NC, USN 

OIC CAPT S.J. KENDRA, MC, USN 
AO LT D.R. GRAY. MSC, USN 

CO CAPT M.F. TANNER, MSC, USN 
DAS CDR J.E. JOHNS, MSC, USN 
CH NURSE CDR C. BELEZOS, NC, USN 
CO RADM D.E. BROWN, JR. , MC. USN 
DCS CAPT W.M. MCDERM01T, MC, USN 
DAS CAPT E.E. FOWLER, MSC, USN 
CH NURSE CAPT F. SHEA, NC, USN 



NAVREGDENCEN, SAN DIEGO, CALIF . 



NAVAL HEALTH RESEARCH CENTER, 
SAN DIEGO, CALIF 



COMNAVBASE, LOS ANGELES, CALIF . 

TWELFTH NAVAL DISTRICT 

NAVREGMEDCEN, OAKLAND, CALIF . 



COMPATWINGSPAC MFT .... 
NAVHOSP, LEMOORE, CALIF . 



NAVREGDENCEN, SAN FRANCISCO, CALIF , 



NAVAL DISEASE VECTOR ECOLOGY AND 
CONTROL CENTER, ALAMEDA, CALIF . . 



NAVAL BIOMEDICAL RESEARCH LABORATORY, 
OAKLAND, CALIF 



, CO RADM W.L. DARNALL, JR., DC, USN 
DCS CAPT E.J. HEINKEL, JR., DC, USN 
DAS CDR W.E. GROCE, MSC, USN 

CO CAPT R.H. RAHE. MC, USN 
XO LCDR W. FERRIS, MSC, USN 
. DO CAPT H.W. HODSON, DC, USN (ADDU) 

. DMO RADM W.M. LONERGAN, MC, USN (ADDU) 
DDO CAPT J.B. HOLMES, DC, USN (ADDU) 
CO RADM W.M. LONERGAN, MC, USN 
DCS CAPT V.M. HOLM, MC, USN 
DAS CDR H.H. SOWERS, MSC, USN 
CH NURSE CAPT L. PETERSON, NC, USN 
DO CAPT W.C. SULLIVAN, DC, USN (ADDU) 

. COCAPTE.B. MILLER, MSC, USN 
DAS CDR F. TEAGUE, MSC, USN 
CH NURSE CDR J. BARNES, NC, USN 
CO CAPT J.B. HOLMES, DC, USN 
DCS CAPT R.P. MORSE, DC, USN 
DAS CDR G. RAMIREZ, MSC, USN 

OIC LCDR R.V. PETERSON, MSC, USN 
AO LTT.W. WILDER, MSC, USN 

. CO CDR J.F. PRIBNOW, MSC, USN 
AO LTJG J.D. FORD, MSC, USNR 



THIRTEENTH NAVAL DISTRICT 

NAVREGMEDCEN, BREMERTON, WASH . 

NAVREGDENCEN, BREMERTON, WASH . 



NAVHOSP, WHIDBEY ISLAND. 
OAK HARBOR, WASH 



NAVCLINIC, NSA, SEATTLE, WASH . 



FOURTEENTH NAVAL DISTRICT 

NAVREGMEDCLINIC, PEARL HARBOR, HI . 
NAVREGDENCEN, PEARL HARBOR, HI . . . 



NAVAL MEDICAL ADMINISTRATIVE UNIT, 
TR1PLER ARMY HOSP, HONOLULU, HI 

NAVAL ENVIRONMENTAL AND PREVENTIVE 
MEDICINE UNIT NO. 6, PEARL HARBOR, HI . 



NAVA1 DISTRICT, WASHINGTON, DC . 

NAVHOSP, ANNAPOLIS, MD 



DMO CAPT R.C. ELLIOTT, MC, USN (ADDU) 
DDO CAPT R.G. THOMPSON, DC, USN (ADDU) 
AO LCDR K.W. SHAFFER, MSC, USN (ADDU) 
CO CAPT R.C. ELLIOTT, MC, USN 
DCS CAPT K.A. GAINES, MC, USN 
DAS CAPT J.J. PALMER, MSC, USN 
CH NURSE CAPT M.G. STEWART, NC, USN 
. CO CAPT R.G. THOMPSON, DC, USN 
DCS CAPT J.E, MILLER, DC, USN 
DAS LT C.E. LAND, MSC, USN 

CO CAPT J.C. SMOUT, MSC, USN 
DCS CAPT D. W. COWHERD, MC, USN 
DAS CDR P.O. D1LLEY, MSC, USN 
CH NURSE CDR K. KENDALL, NC, USN 
CO CAPT C.F. TEDFORD, MSC, USN 
XO LCDR K.W. SHAFFER, MSC, USN 
SR NURSE LCDR V.E. BOYCE, NC, USN 

DMO CAPT S. A. YOUNGMAN, MC, USN (ADDU) 
DDO CAPT R.W. BRUCE, DC, USN (ADDU) 
AO CDR D.R. FERGUSON, MSC, USN (ADDU) 
CO CAPT S.A. YOUNGMAN, MC, USN 
DAS CDR D.R. FERGUSON, MSC, USN 
SR NURSE CDR J.A. MORTON, NC, USN 
. CO CAPT R.W. BRUCE, DC, USN 
DCS CAPTT.F. MCCANN, DC, USN 
DAS LCDR J.D. DELAUGHTER, MSC. USN 

OICCDRB.L. STEPHENS. MSC, USN 

OIC CDR T.R. BYRD, MC, USN 
AOLT J.M. CONSENZA, MSC, USN 



DMO RADM J.T. HORGAN, MC, USN (ADDU) 
DDO CAPT S.T. ELDER, DC, USN (ADDU) 
. CO CAPT J.D. PRUITT, MSC, USN 
DCS CAPT R.A. PROULX, MC, USN 
DAS (VACANT) 
CH NURSE CDR L. NICKERSON, NC, USN 



WAV MED Newsmakers 



"Hey, I like the looks of those 
new Navy uniforms," thought the 
pretty blond beaming at the bright 
flowers and pointed hat sported by 
LT Kevin Kerrigan, MC, USNR on 
his visit to the NRMC Camp Le- 
jeune Dependents Clinic. Then she 
got an eyeful of HM2 Jerry Hillin. 




Hillin (left), Kerrigan & admirer 




HM2 McDowell: ' I 've been able to help' 



"Wow, some beard! The Navy's 
really getting with it. Maybe if I 
wish hard they'll bring back bell 
bottoms." Funny about those Hal- 
loween wishes . . . 



She's a familiar character on TV: 
the spunky young mother, working 
and raising a family by herself, 
"One Day At a Time," through the 
joys and trials of "Alice" and "The 
Partridge Family." She's a familiar 
character at NRMC San Diego, too. 
Only there she's HM2 Janet Mc- 
Dowell, former assistant leading 
petty officer for the dependent pri- 
mary care clinic and now assigned 
to the center's Military Personnel 
Office. 

On the job she oversees the 
check-in process for all enlisted 
Medical Department members re- 
porting to the regional medical cen- 
ter or its outlying clinics. At home 
she guides an energetic 10-year-old 
son, James. And because she's also 
a licensed vocational nurse and a 
member of the California Fire Res- 
cue and Paramedic Association, 
HM2 McDowell spends some of 
her free time as an emergency med- 
ical technician. 

"Knowing I've been able to help 
people is the biggest reward I get as 
a hospital corpsman," she says. 



CDR Joan Bynum (NC) didn't ex- 
pect to see her name on the latest 
list of staff corps captain selectees: 
she hadn't realized she was even in 
the selection zone. But her selection 
gave her a sure place in Navy his- 
tory as the first black woman to 
wear the coveted four gold stripes. 

At NRMC Great Lakes, CAPT- 
selectee Bynum is nursing coordina- 
tor for the coronary care unit, gen- 
eral medicine and infectious disease 
wards, newborn nursery, and post- 
partum ward. When asked about 
her professional goals, the 19-year 



Navy veteran replies, "I'm happy to 
take whatever the Navy sends my 
way." 

It was a relaxed summer day in 
Okinawa — perfect for a trip to the 
pool. And the three Navy hospital 
corpsmen, busy with a Red Cross 
water survival lesson, fit right in 
with all the other swimmers and 
sunbathers. Suddenly, a crisis: the 
kind that shows why hospital corps- 
men deserve their reputation for 
excellence. A man sitting at the 
pool's edge fell backwards, gasping 
for breath. Marine Corps SSGT 
Robert Faye rushed to his side and 
began resuscitation. He was quickly 
relieved by HA Steven Morse, HM2 
Duane Curtis and HM3 Terrance 
Pair, who alternately provided arti- 
ficial resuscitation and life-suppor- 
tive first aid. After about half an 
hour the victim had recovered 
enough to be taken to a hospital. 
For this noteworthy act of mercy, 
the rescuers received a Red Cross 
Certificate of Merit and accompany- 
ing pin. This is the Red Cross's 
highest award for people who save a 
life using skills learned in Red Cross 
first aid, small craft, or water safety 
training programs. 




CAPT-selectee Bynum: First for lour 



Volume 68, October 1977 



15 



Off Duty 

Meet Dr. All Thumbs 



Dr. All Thumbs takes her clown- 
ing seriously. But the laughter she 
invokes isn't heard in a circus tent: 
instead, it rings through the wards 
of Naval Regional Medical Center 
San Diego, where ailing and some- 
times critically ill children are cared 
for. 

HM3 Venita E. Patterson has that 
rare type of creative talent which 
sometimes just overflows into her 
work. As "Dr. All Thumbs," a cer- 
tified clown, she combines her en- 
tertainment skills with her health 
care training, using her comical 
antics to ease the sometimes appre- 
hensive young patients. 

Jesting. Whether she's jesting at 
a picnic for children stricken with 
leukemia or entertaining in a 
crowded clinic waiting room, HM3 
Patterson simply likes making peo- 
ple laugh. 

"I think a lot of times the way you 
approach a child determines your 
rapport with him," she says. "If 
you're jolly and joke with him, he 
starts to relax a little and think, 
'Hey, this person isn't so bad after 
all.' 

"You have to know how to read 
kids, because you can really scare 
them. You have to learn how to ex- 
plain things in simple terms so they 
can understand, and you have to go 
about your work in a calm manner." 

HM3 Patterson says she has al- 
ways wanted to be in medicine: 
"Ever since 1 was small, the health 
field fascinated me. I did a lot of 
volunteer work in occupational ther- 
apy when I was a student in New 
Mexico — over 300 hours — and I got 
my start there in emergency 
rooms. 

"But I've always wanted to be a 
clown, too. I am one, anyway. I've 
been a clown without makeup for 
many, many years. Finally I decided 



to go one step further and get the 
makeup." 

HM3 Patterson joined the Navy in 
1975 to help support her mother 
who suffers from glaucoma and 
cataracts. She was also interested in 
educational benefits: before joining, 
she spent three semesters at the 
University of New Mexico at Albu- 
querque, working part-time to cover 
expenses. 

Opportunity. After completing 
Hospital Corps School at Great 
Lakes, 111., HM3 Patterson was as- 
signed to NRMC San Diego, where 
working in the emergency room 
gives her the diversification she 
likes. 

"I have to have a lot of change in 
my life," she says. "I like working 
in the emergency room because it 
never gets boring." 

The opportunity to become a pro- 
fessional clown presented itself by 
accident, HM3 Patterson says. She 
happened to see graduation cere- 
monies for "clownology" majors at 
San Diego State University, and 
decided she just had to do it herself. 

To attend the university's last 
scheduled 18-week course in clown- 
ology, the 21-year-old petty officer 
got special permission to work at 
night in the emergency room. The 
Navy also paid for three-quarters of 
her tuition under the Tuition Aid 
Program . 

"In school we learned how to put 
on the makeup and all about cos- 
tuming," she says, her expression 
animated. "We designed our own 
face, our own costume, and charac- 
ter. I took the name of Dr. All 
Thumbs because most kids who 
come into the emergency room are 
really apprehensive and scared — 
anybody in white scares them. 

"So I figured I'd be a doctor- type 
clown. I'd wear white and put some 




Dr. All Thumbs coaxes a smile 

patches on, so the kids wouldn't 
associate bad things with people in 
white." 

Her insistence on creating a 
costume that would help the chil- 
dren at work didn't sit well with her 
instructor, who had a more tradi- 
tional view of the colors of clownery. 

"He didn't like it at all," HM3 
Patterson remembers. "He said I 
should color my lab coat pink or 
some other color. But I told him that 
I work with kids. When children 
walk into the emergency room 
they're petrified. That's why I left 
my coat white — to try and lessen the 
fears they have." 

Although she's never worked a 
full day in her clown outfit or worn it 
while performing any antiseptic 
chores, HM3 Patterson has gone 
into the emergency room and en- 
tertained, sometimes using puppets 
as animated examples for children. 

Occasionally, she also will drop 
by the Pediatric Clinic when it's 
busy, go out into the lobby and 
clown around for a while, to make 
the children's waiting time a little 
more enjoyable. 

Variations. When not at the medi- 
cal center, HM3 Patterson spends 



16 



U.S. Navy Medicine 




HM3 Patterson with young patient: "The emergency room never gets boring" 




Dr. All Thumbs gets a big hug 

part of her spare time with the 
Clownology Alumni Association at 
Scripps Cottage on San Diego State 
University campus. There are 60 
paid members, including one wom- 
an in her 70's. Members must com- 
plete a probationary period before 
being voted into the club. 

"You just can't walk in off the 
street wanting to be a clown and 
slap on some makeup/' HM3 Pat- 
terson says. "All the people here 
are pretty well into it profession- 
ally." 

She explains that there are three 
variations of clowns to choose from 
when a student decides on a partic- 
ular face and personality: the 
tramp, like Emmett Kelly; the white 




HM3 Venita E. Patterson 

"The children make it worthwhile" 

face, or more serious Ronald Mc- 
Donald type; and the august, exag- 
gerated buffoon. 

"The august is the real come- 
dian," HM3 Patterson says. "In 
school we experimented with each 
type of makeup until we found 
something that we liked and that 
matched our personality. It's a very 
individual thing." 

Her association with the alumni 



club together with two courses in 
magic from two San Diego magi- 
cians has helped land her some 
small jobs. She performs at chil- 
dren's birthday parties, small get- 
togethers, business promotions, 
grand openings, and was recently 
invited to perform at the San Diego 
Junior Chamber of Commerce 
Spring Festival. 

Real success. As the most re- 
warding event in her clowning 
career, HM3 Patterson remembers 
an Easter picnic for pediatric hema- 
tology patients. "There were about 
15 children and parents down at the 
hospital chapel," she recalls. "The 
children ranged from little babies to 
12-year-olds. They didn't know that 
I was coming — all they knew was 
that there would be a surprise. 

"It was really neat, because the 
kids were just thrilled. We had 
lunch, an Easter egg hunt, and I 
made balloons for all of them and 
put on a magic show. The picnic was 
a real success. 

"I knew that some of those chil- 
dren were dying, and it was satisfy- 
ing to think that I brought a little bit 
of happiness into their lives. Any 
time I can do something like that, or 
make a hospital visit, it's always 
worthwhile. Any joy I can bring the 
children makes it worthwhile." 

Although HM3 Patterson says 
her future is as uncertain as her 
zany and unpredictable capers as a 
clown, she does hope to stay in the 
health care field. She credits her 
Navy experience for giving her a 
chance to grow. 

"It's helped out a lot financially, 
given me time to think, and also the 
time to do justice to home and 
family," says the young hospital 
corpsman. "I've had more time to 
plan, an opportunity to save money, 
and the chance to do some trav- 
eling." 

HM3 Venita "Dr. All Thumbs" 
Patterson can best be described in 
the words she chose for her busi- 
ness cards: "Behind all smiles and 
frowns of clowns are people who 
love." 

— Story by John Brtndley. Photos by PH2 
Bob Weissleder, 



Volume 68, October 1977 



17 



Scholars' Scuttlebutt 



Taxes: What's in Store for AFHPSP Students? 



Under the provisions of Public 
Law 94-454 of 4 Oct 1976, students 
who entered the Armed Forces 
Health Professions Scholarship Pro- 
gram (AFHPSP) on or after 1 Jan 
1977 are subject to federal income 
tax withholding. Students who en- 
tered the AFHPSP before 1 Jan 
1977 are not subject to federal in- 
come tax withholding for calendar 
years 1976, 1977, 1978 and 1979. 
However, all AFHPSP students will 
be subject to withholding during 
calendar year 1980 and thereafter. 

Legislation to exempt AFHPSP 
students from federal income tax 
has been introduced in both the 
House and the Senate. As of 1 Sept 
1977, three bills had been submitted 
to the House Ways and Means 
Committee: HR-5190, introduced by 
James Jones (D-OK); HR-7944, 
introduced by William Natcher (D- 
KY); and HR-7993, introduced by 
Timothy Carter (R-KY). In the 
Senate, Sen. Wendell Ford (D-KY) 
and Sen. Walter Huddleston (D-KY) 
have submitted S-1698 to the Senate 
Finance Committee. 

As the situation now stands, most 
new AFHPSP students will experi- 
ence a severe cut in their first 
monthly stipends. This is because 
all federal income tax due on 1977- 
78 academic year tuition payments 
made in calendar year 1977 must be 
withheld from the three or four 
monthly stipend checks these stu- 
dents will receive in 1977. In calen- 
dar year 1978, federal income tax 
withholding will be spread over the 
entire calendar year — except for 
students who enter the AFHPSP 
late in 1978. 

Recent discussions with the Navy 
Finance Center in Cleveland indi- 
cate that the following formula will 
be used to calculate a student's 
gross monthly income subject to 
withholding: 



X = T + $400 
(M-l) 
Where 
X = Gross monthly income sub- 
ject to federal income tax 
withholdings. 
T = Estimate of tuition and fees 
to be paid to the school dur- 
ing the calendar year. 
(M-l) = Number of months in a 
taxable year adjusted for one 
45-day active-duty for train- 
ing (ACDUTRA) period. 
$400 = Unadjusted stipend pay- 
ment. 
The "T" value in the above for- 
mula is a function of the school's 
billing cycle and reflects when, dur- 
ing a particular calendar year, the 
student came into the program. For 



example, most students come into 
the program during the last half of a 
calendar year when most schools 
commence their academic year. If 
the school bills the Navy for the 
entire upcoming academic year, the 
"T" would equal one full year's 
tuition and fees. On the other hand, 
if the school bills by the semester, 
the "T" would equal half of one full 
year's tuition and fees. In the case 
of students whose participation in 
the program spans an entire calen- 
dar year, "T" would always equal a 
full year's tuition and fees. 

The "M" value is entirely a func- 
tion of the number of months during 
a calendar year that a particular 
student is a member of the pro- 
gram. 



TABLE I . Monthly Tax Table to be Used for Stipend, Tuition and Fees 



SINGLE 



IF WAGE IS: 
Not over $142 



TAX WILL BE: 
-0- 



Over 


But not over 














$ 142 


$ 329 






16% 


of 


excess over 


$142 


329 


621 


$29.92 


+ 


18% 




" 


329 


621 


788 


82.48 


+ 


22% 




n 


621 


788 


954 


119.22 


+ 


24% 




1 1 


788 


954 


1288 


159.06 


+ 


28% 




11 


954 


1288 


1538 


252.58 


+ 


32% 




i * 


1288 


1538 




332.58 


+ 


36% 




i f 


1538 






MARRIED 














IF WAGE IS: 






TAX WILL BE: 






Not over S263 










-0- 




Over 


But not over 














$ 263 


$ 454 






15% 


of 


excessover 


$263 


454 


965 


$ 28.65 


+ 


18% 




! T 


454 


965 


1204 


120.63 


+ 


22% 




t f 


965 


1204 


1538 


173.21 


+ 


25% 




1 1 


1204 


1538 


1871 


256.71 


+ 


28% 




M 


1538 


1871 


2204 


349.95 


+ 


32% 




it 


1871 


2204 




456.51 


+ 


36% 




1 1 


2204 



18 



U.S. Navy Medicine 



The following example may serve 
as a guide for students who wish to 
estimate their tax liability and re- 
sulting monthly stipends: 
Program entrance date: 

September 1977 
School billing cycle: Semester 
Tuition estimate: $4,000 per year 
Marital status: Single 
Unadjusted stipend: $400 

1) Find the gross monthly income 
subject to withholding (X): 

X = T + $400 
(M-l) 

X = $2000 + $400 

(4-1) 

X = $2000 + $400 



X = $667 + $400 

X = $1067 

2) Use the tax table in Table I to 
determine tax liability on gross 
monthly income. In this example, 
tax liability is $190.70 ($159.06 + 
28% of excess over $954). 

3) Subtract the tax liability 
($190.70) from the monthly stipend 
to find the amount that will appear 
on each monthly check. In this case, 
the student would receive $209.30 
each month ($400 less $190.70). 

Since new AFHPSP students 
enter the program at various times 
throughout a given month, their 
first stipend check will reflect 
money granted for a partial month 
less the amount withheld for federal 
income tax. Therefore, students 
who enter the program late in the 
month would receive a very small 
check, or possibly no check at all. 
All subsequent checks will reflect a 
full month's stipend payment ($400) 
less the amount withheld for federal 
income tax. Also remember that the 
"M" value will change to 12 in 
January 1978 for students who 
entered the program during the 
current calendar year. 

Federal income tax will also be 
withheld from a student's claim for 
reimbursement. In this instance, 



14% of the reimbursable expense 
will be deducted as federal income 
tax. This deduction will be taken 
each time a reimbursement claim is 
submitted. 

Near the end of each year, the 
Naval Health Sciences Education 
and Training Command will provide 
the Navy Finance Center with a list 
of the actual tuition costs for each 
student subject to federal income 
tax withholding during the calendar 
year. The finance center will use 
this list to compute actual gross 
income for annual W-2 statements. 



Sometime near the beginning of 
each calendar year, students will re- 
ceive a W-2 statement reflecting 
gross income for the previous calen- 
dar year based on stipend, tuition, 
and fees. Other W-2 statements re- 
flecting income from reimbursables 
and ACDUTRA will have been is- 
sued earlier during the calendar 
year: W-2 statements reflecting re- 
imbursables are issued with each 
reimbursement check; statements 
reflecting ACDUTRA are issued at 
the completion of the training 
period. 



BUMED SITREP 



PHOTOS AND BIOGS ... The Chief of 
Naval Personnel requires all officers on 
active duty, whether USN or USNR, to 
submit official photographs and biogra- 
phy sheets at certain times during com- 
missioned service. BUMED also has a 
continuing need for updated photo- 
graphs and biography sheets of Medical 
Department officers, to keep files cur- 
rent and for use in considering various 
assignments and training. 

COs of BUMED-commanded activi- 
ties are requested to bring the provi- 
sions of BUPERS Manual article 
5020140 to the attention of all members 
of their command, and to direct compli- 
ance in updating official records by sub- 
mitting photographs and biography 
sheets. Copies should be submitted to 
cognizant corps codes in BUMED as fol- 
lows: Medical Corps— Code 31; Nurse 
Corps— Code 32; Dental Corps— Code 
613; Medical Service Corps — Code 711; 
Physician's assistants — Code 31. 

STAFF PLANNING COURSE ... The 

Landing Force Training Command Pa- 
cific conducts medical staff planning 
courses at the Medical Inservice Train- 
ing Section, First Marine Division, 
Camp Pendleton, Calif. This one-week 
course offers 35 hours of classroom in- 
struction in medical aspects of amphibi- 
ous operations, primarily at the landing 
force level. Subjects include: introduc- 
tion to amphibious operations; amphibi- 
ous task force organization and com- 
mand relations; embarkation planning; 
logistics planning; medical estimates; 
casualty estimates; medical support of 
the landing force; combat medical sup- 



ply/authorized medical allowance lists; 
and development of the medical annex. 
A few openings in this course are 
available to Medical Department offi- 
cers serving in or ordered to billets in- 
volving medical support to Fleet Marine 
Force elements. Information on class 
schedules and quotas may be obtained 
from the Division Surgeon, 1st Marine 
Division, FMF, Camp Pendleton, Calif. 
92055. Phone: (Area code 714) 725- 
3521/4744; Autovon 993-3521/4744. 

CONTINUING EDUCATION ACCRED- 
ITED . . . The Naval Health Sciences 
Education and Training Command has 
been accredited by the Northeast Re- 
gional Accrediting Committee of the 
American Nurses Association for a 
period of four years as a provider of and 
approval body for continuing education 
in nursing. 

This accreditation permits continuing 
education recognition to be awarded 
participants in Medical Department 
nursing continuing education programs 
which meet acceptable national stand- 
ards. Such recognition may be applied 
toward state requirements for individ- 
ual relicensure. 

AUDIT TD?S . . . Commands may wish 
to review the following recommenda- 
tions from a Navy Audit Service report: 

• Record and tag all Class 3 plant prop- 
erty items and dispose of excess Class 3 
plant property, as required by NAV- 
COMPT Manual, par. 036304-2. 

• Perform triennial inventories of Class 
3 plant property, in accordance with 
NAVCOMPT Manual, par. 036208. 



Volume 68, October 1977 



19 



Policy 



Safety Tips 



Nonflammable Medical Gas Systems 



CDR John P. Swope, MC, USN 
BUMED, Code 416 



Previous "Safety Tips" have addressed the use of 
medical gases in such patient care areas as anesthetiz- 
ing locations and respiratory therapy areas. This article 
will concern itself with the piping systems of nonflam- 
mable medical gas systems (piping systems are not 
used with flammable gas). 

Nonflammable medical gases include but are not 
limited to oxygen, nitrogen, nitrous oxide, medical 
compressed air, carbon dioxide, helium, and mixtures 
of such gases when used for medical purposes. Al- 
though oxygen and nitrous oxide are nonflammable 
gases, they provide an oxidation substance that accel- 
erates the combustion process. 

An important requirement for nonflammable medical 
gas systems is oxygen compatibility. National Fire Pro- 
tection Association (NFPA) Standard 56F requires that 
all elements of a medical gas system be compatible with 
oxygen. This includes not only the deterioration of 
materials when exposed to oxygen, but also materials 
that may be easily ignitable — such as oil. 

In NFPA 56F, there are two separate constraints: the 
first constraint is to maintain sources of supply for pa- 
tient care; the second, to minimize associated hazards 
in the operation, installation and testing of medical gas 
systems. 



SOURCE OF SUPPLY 

Cylinder systems. Two sources of gas supply allowed 
under NFPA 56F are a cylinder system without reserve 
supply, and a cylinder system with a reserve supply. 
Each cylinder system shall be composed of two sepa- 
rate banks of cylinders which supply gas to the pipe- 
line. These cylinders shall be so arranged that when 
one bank is depleted the system automatically switches 
to the second bank. Banks must be large enough to hold 
several days' supply unless delivery schedules are so 
infrequent that a greater supply must be maintained. 
There shall be a check valve arrangement in these sys- 
tems to ensure that when one bank is depleted, it will 



not deplete the other bank. This cylinder system with 
reserve supply shall have, in addition to the above- 
mentioned two banks, a reserve supply which shall 
operate automatically in the event that both the primary 
and secondary supplies are unable to supply the pipe- 
line. The reserve supply shall consist of three or more 
manifolded high-pressure cylinders. 

Cylinders used in the medical nonflammable gas 
system shall be designed, constructed, tested, and 
maintained according to Department of Transportation 
specifications and regulations. The pressure in these 
nonflammable medical gas systems shall be between 50 
and 55 pounds per square inch gauge (psig) at all out- 
lets. The pressure-regulating equipment shall be 
capable of maintaining a minimum flow rate. Nitrogen 
medical gas systems shall be capable of delivering at 
least 160 psig to all outlets at maximum flow. 

Storage. This standard sets forth pressure relief 
valve requirements within the storage area for non- 
flammable medical gas systems to ensure that pressure 
will not build, without relief, to such a point that the 
pipeline bursts. The room where supply systems are 
stored shall have lockable doors or gates, and shall not 
be used to store anything other than nonflammable gas 
cylinders. Empty cylinders may be stored in these en- 
closures. To prevent damage, electrical wall Fixtures in 
these rooms shall be installed in fixed locations not less 
than five feet above the floor. Storage rooms located 
within a building shall have a two-hour fire rating as 
stated in the NFPA 220 Standard, "Types of Building 
Construction." Smoking shall be prohibited in these 
enclosures. The rooms shall be heated by steam, hot 
water or other indirect means. Cylinder temperatures 
shall not exceed 130° F. 

Air compressors. Medical air compressors shall be 
kept separate from the cylinder gas systems or storage 
enclosures. The compressors shall take their source of 
air from the outside atmosphere and shall not add con- 
tamination in the form of particulate matter, odor, or 
other gases. Compressors shall be oil free; equipped 
with an intake filter-muffler of the dry type, after 



20 



U.S. Navy Medicine 



cooling, or an air dryer; and have a downstream pres- 
sure-reducing regulator. These devices ensure that the 
system will add no contamination to the medical com- 
pressed air provided for the patient. Antivibration 
mountings shall be installed, in accordance with the 
manufacturer's recommendations, under these air 
compressors, and flexible coupling shall interconnect 
the air compressor, its receiver, intake lines, and the 
supply lines from the storage receiver. 

Piping systems. NFPA 56F also discusses pipeline 
systems, and sets forth criteria for materials and tech- 
niques used to construct pipelines. All pipelines shall 
be identified with the name of the gas contained. The 
standard describes how the system shall be protected 
against physical damage, and includes guidance for 
protecting buried pipeline systems and pipelines which 
could be damaged from bumpings with carts, stretch- 
ers, trucks, and so forth. 

Shutoff valves. The pipeline system shall have shut- 
off valves, accessible only to authorized personnel; the 
valves shall be installed in boxes with frangible or re- 
movable windows large enough to permit the valves to 
be operated by hand. Each valve shall be labeled with 
the name of the gas it supplies and the area to which 
the gas is provided. 

Station outlets. Each station outlet for the gas shall 
be equipped with either a hand-operated or automatic 
shutoff valve legibly labeled with the name of the gas. 
Each station outlet shall have a noninterchangeable 
connection (either a diameter index safety system or a 
female member of an approved noninterchangeable 
quick coupler appropriate for the medical gas service). 
Each medical gas delivery line that services an anes- 
thetic apparatus through a yoke insert shall have a 
check valve installed in the line immediately adjacent to 
the yoke insert; this check valve will prevent backflow 
from the small cylinder that is attached to the same 
valve and that holds medical gas under high pressure. 
This arrangement will minimize the possibility of acci- 
dental rupture of the connecting hose and piping 
systems should it be necessary to open the small cylin- 
der in an emergency. 

Station outlets in patients' rooms shall be located ap- 
proximately five feet above the floor or in a recess; this 
will help avoid damage to the valve or control equip- 
ment — such as sometimes occurs when humidifing 
bottles are attached, for example. 

Warning systems. There shall be two warning 
systems to monitor the function of the pipeline system. 
Both shall be supplied by normal and emergency elec- 
trical power systems. The first warning system is the 
operating alarm which sounds just before or at the time 
of changeover from one bank of cylinders to another. 
The emergency alarm system will sound when the 
supply system is not functioning properly and shall be 
actuated by any of the following conditions: low or high 
pipeline pressure, operation of reserve supply, or loss 
of reserve supply. 



INSTALLING AND TESTING SYSTEMS 



In the final chapter of NFPA 56F, installation and 
testing of pipeline systems are discussed. All piping 
valves and fittings except those furnished by the manu- 
facturer as especially prepared for oxygen service and 
received sealed shall be thoroughly cleaned of oil, 
grease, and other readily oxidizable materials by being 
washed in a hot solution of sodium carbonate or tri- 
sodium phosphate. Scrubbing shall be employed, when 
necessary, to ensure complete cleaning; after washing, 
the material shall be rinsed thoroughly in clean hot 
water. Particular care shall be exercised in storing and 
handling pipes and fittings. Tools for cutting or 
reaming the pipelines shall be kept free from oil or 
grease. Where such contamination has occurred, the 
items affected shall be rewashed and rinsed after in- 
stallation of the piping, but before installation of the 
valve outlets. All the lines shall be blown clean with 
oil-free dry air or nitrogen. 

Pressure testing. After it is installed, the system 
shall be pressure- tested with oil-free dry air or nitrogen 
using a pressure of 1-1 Yi times the maximum working 
pressure, but not less than 150 psig. Tests shall be 
maintained until each joint has been examined for leak- 
age using soapy water or another equally effective 
means of leak detection that can be used safely with 
oxygen. 

Standing pressure test. The pressure may be allowed 
to change only with a temperature change. The formula 
for allowable pressure change is given in this standard. 

Cross connection test. To determine that no cross 
connection to other pipeline systems exists, all systems 
shall be reduced to atmospheric pressure and all 
sources of test gas to all systems shall be disconnected. 
Then each system shall be pressurized individually and 
each outlet checked to assure that only that system is 
pressurized. The other outlets shall also be checked to 
make sure there is no cross connection. Prior to opera- 
tion, all outlets shall be opened to purge and flush the 
pipeline system; afterwards, the outflow from each 
designated and labeled medical gas outlet station shall 
be tested to confirm the presence of the designated gas. 
An oxygen analyzer shall be used to confirm that the 
oxygen is of the desired purity. All medical gas pipeline 
systems shall be tested after each alteration or repair of 
the system to assure that only the gas for which the 
system is designated is being used. 



SUMMARY 



This has been a brief summary of the NFPA standard 
for nonflammable medical gas pipeline systems. By fol- 
lowing the guidelines for installation and testing, many 
tragedies that have occurred could have been avoided. 



Volume 68, October 1977 



21 



Instructions and Directives 



Financing "productivity enhancement" 
projects 

NAVCOMPT Instruction 7000.38 sets forth Depart- 
ment of the Navy policy with respect to financing pro- 
ductivity enhancement/fast payback capital invest- 
ment opportunities, and establishes procedures for 
identifying items, funding, and follow-up reporting. All 
projects of a commercial or industrial nature must 
undergo cost analysis. Projects which do not fully meet 
requirements for in-house operations cannot be sub- 
mitted. A copy of this cost analysis must be included in 
the project file and retained at the local level. 

Productivity enhancement projects identified at naval 
medical activities shall be submitted via BUMED Code 
463. All projects submitted shall be included in the in- 
vestment equipment budget for the facility. — BUMED 
Instruction 7000.5 of 14 June 1977. 

Medical/dental and subsistence rates, 
and hospital bills 

The full reimbursement rate for hospital care pro- 
vided non-U.S. citizen employees of the U.S. at over- 
seas activities is now $168 per day. The full outpatient 
rate for these individuals is $20. 

No charge will be made for newborns while the 
mother is hospitalized. If the infant remains after the 
mother is discharged, the rate prescribed for the 
mother will apply except for infants of active-duty per- 
sonnel and ex-service maternity patients. In those in- 
stances, the infant will be charged the dependent rate. 

As a general rule, only one charge will be levied per 
patient per day regardless of the number of outpatient 
visits recorded or ancillary services provided. No 
charge will be made for outpatient visits which result 
in the patient's admission to the hospital the same day. 

The full outpatient rate covers medical and dental 
outpatient care provided civilians employed by the 
U.S., as well as their dependents, when payment is 
made by the patient or insurance carrier and not the 
patient's sponsoring agency. This rate includes 
physical examinations for domestic help. Note that free 
emergency "on-the-job" medical care is provided civil- 
ian employees through the Federal Employee Health 
Program.— BUMED Notice 6320 of 15 June 1977. 

Medical/Dental Equipment Maintenance 
and Repair Manual 

To ensure optimum equipment readiness, a mainte- 
nance and repair program for medical and dental equip- 
ment will be carried out with maximum practicable use 
of inservice organizational resources. Provisions of the 
Medical/Dental Equipment Maintenance and Repair 
Manual, applicable to all Navy and Marine Corps activ- 

22 



ities having medical or dental personnel assigned (in- 
cluding medical and dental departments of the operat- 
ing forces), shall be implemented promptly. 

Report MED 6700-19 is cancelled. Also, BUMED In- 
struction 5101.3 and NAVMED 5101/1, Electric Bed 
Inspection Form, are cancelled. — BUMED Instruction 
6700.36A of 17 June 1977. 

Navy Acute Minor Illness Clinic Program 

Naval medical facilities shall review their patient 
screening programs and use of Hospital Corps mem- 
bers as primary care screeners to determine whether a 
Navy Acute Minor Illness Clinic Program is required. If 
such a need is identified, guidelines for a standardized 
program may be obtained from the Naval Health Sci- 
ences Education and Training Command, Bethesda, 
Md. 20014. 

When developing NAMIC Programs, these policies 
shall apply: 

• NAMIC personnel should be E-3 or E-4 hospital 
corpsmen (HM-0000). 

• Billets must come from current resources, and should 
be titled "clinical assistant (NAMIC)." 

• The limited NAMIC Program may be developed con- 
sistent with HSETC guidelines. [NOTE: The full capac- 
ity program is under review; availability will be an- 
nounced.]— BUMED Notice 1510 of 24 June 1977. 

Blood donor centers and transfusion services 

Each Navy health care facility is responsible for 
establishing rules and regulations governing the selec- 
tion of suitable blood donors, collection and processing 
of whole blood or blood components, selection of com- 
patible blood for the recipient, and proper procedures 
for administering blood. Minimum procedural require- 
ments are set forth in the enclosure to BUMED Instruc- 
tion 6530. 6C of 15 July 1977, and in the references 
listed in that instruction. 

Practical Comptrollership Course 

The two-week Practical Comptrollership Course at 
the Naval Postgraduate School, Monterey, Calif., is 
designed for military and civilian personnel who hold or 
are about to assume responsible positions in financial 
management. The course helps students acquire the 
skills and knowledge they need to serve as comptroller, 
assistant comptroller, accounting officer, budget offi- 
cer, or head of the internal review staff. 

Travel and per diem costs will be funded by BUMED 
beginning in FY78. Commands shall submit the name, 
grade or rate, Social Security number, and position title 
of personnel nominated to attend this course to 
BUMED Code 46A, by the nomination deadline. 

Class dates (nomination deadlines in parentheses) 
are: 5-16 Dec 1977 (25 Oct 77); 13-24 Mar 78 (25 Jan 
78); 5-16 Jun 78 (25 Apr 78).— BUMED NOTE 5300 of 4 
Aug 1977. 

U.S. Navy Medicine 



Notes & 
Announcements 



DENTAL CONTINUING EDUCATION COURSES 

The following dental continuing education courses 
will be offered in January 1978: 

National Naval Dental Center, Bethesda, Md. 

Oral pathology 9-13 Jan 1978 

Removable partial dentures 23-25 Jan 1978 

Eleventh Naval District, San Diego, Calif. 

Removable partial dentures 9-11 Jan 1978 

Oral pathology 23-27 Jan 1978 

Maxillofacial prosthetics 30 Jan- 1 Feb 1978 

U.S. Army Institute of Dental Research, Walter Reed 
Army Medical Center, Washington, D. C. 

Oral surgery 9-12 Jan 1978 

Requests for courses administered by the Comman- 
dant, Eleventh Naval District, should be submitted to: 
Commandant, Eleventh Naval District (Code 37), San 
Diego, Calif. 92132. Applications for other dental con- 
tinuing education courses should be submitted to: Com- 
manding Officer, Naval Health Sciences Education and 
Training Command (Code 5), National Naval Medical 
Center, Bethesda, Md. 20014. Applications should ar- 
rive six weeks before the course begins. 

Cross-country travel and travel from outside the con- 
tinental U.S. to attend dental continuing education 
courses generally will not be approved due to funding 
limitations. 

NURSE CORPS CONTINUING EDUCATION 
COURSES APPROVED 

The quarterly meeting of the Nurse Corps Continuing 
Education Approval and Recognition Program (CEARP) 
review board convened in July 1977 at the Naval Health 
Sciences Education and Training Command, Bethesda, 
Md. The following 43 continuing education programs 
were approved for the contact hours indicated in paren- 
theses: 

NRMC Portsmouth, Va. 
Critical Care Nursing (60) 

NRMC Charleston, S.C 

Leadership and Management Training Course (80) 

NRMC Jacksonville, Fla. 

Coronary Care Course (ROCOM) (80) 

Fire Emergency in a Patient Care Facility (4) 

Basic Life Support (Cardiopulmonary Resuscitation) (8) 

Current Aspects of Maternal-Child Health (30) 

Ostomy Care (2) 

NRMC Great Lakes, III. 
Precepts on Dying (12) 



NH Patuxent River, Md. 

Patient Contact Point Training Curriculum (6) 

NRMC Corpus Christi, Tex. 

Basic Life Support (Cardiopulmonary Resuscitation) (4) 
Intravenous Certification Program (4) 

NRMC Oakland, Calif. 

Basic Cardiopulmonary Resuscitation (6) 
Hypertension — A Symposium for Nurses (30) 

NH Whidbey Island. Oak Harbor, Wash. 
Nursing Today (3) 
Communication Skills Workshop (6) 
Prepared Childbirth — The Lamaze Method (3) 

NRMC Memphis, Tenn. 
Basic Life Support (Cardiopulmonary Resuscitation) (10) 
Patient-Oriented Medical Records (4) 
Care Plans (7) 

Recognition of Arrhythmias (60) 
Insertion of an Intravenous Teflon Catheter Placement Unit (8) 

NRMC New Orleans, La. 

Care of the Ostomy Patient (2) 

Physical Assessment: Lungs and Thorax, Abdomen, and Heart (6) 

NSMC Groton, Conn. 

Coronary Care Nursing (48) 

Nursery Care Course (27) 

Care of the Patient with Cancer of the Breast (2) 

Care of the Patient with Severe Preeclampsia and Resultant Renal 

Failure (2) 
Care of the Patient with Respiratory Dysfunction (2) 
Care of the Patient Undergoing Renal Dialysis (2) 

NRMC Camp Pendleton, Calif. 
Critical Care Course (60) 

Management: Human Relations/Performance Evaluation (24) 
National Critical Care Course (60) 
Auditing the Nursing Process: The Question of Accountability (5) 

NRMC Camp Lejeune, N.C. 
Basic Coronary Care (35) 
Nursing Assessment and Problem-Oriented Patient Care Planning 

Workshop (8) 
Advanced Renal Care (4) 
Basic Renal Care Course (4) 
Basic Orthopedic Care (4) 

NARMC Pensacola, Fla. 

Intensive Care Unit Course (80) 

NRMC Newport, R.I. 

Oncology: An Overview III (1 .5) 

Intravenous Certification Program (4) 

Basic Life Support (Cardiopulmonary Resuscitation) (6) 

NNMC Bethesda, Md. 

Physical Assessment of the Adult Chest and Thorax (2) 

Nurse Corps officers interested in attending one of 
these courses should request a quota from the host 
command. 

Accreditation of the Navy Nurse Corps CEARP by the 
Northeast Regional Accrediting Committee of the 
American Nurses Association precludes retroactive 
approval of offerings. Programs should be submitted 
for review 30 days before first presentation date. 



Volume 68, October 1977 



23 



Clinical Notes 



Cannulating Wharton's 
Duct During Biopsy 

CAPT Edward L. Mosby, DC, USN 



Oral surgeons often perform biopsies of lesions on 
the floor of the mouth near the ducts of the submandib- 
ular gland. When excisional biopsy is indicated, there 
is always a danger of inadvertently or unknowingly 
severing one or both of Wharton's ducts. I will describe 
a simple way to locate the submandibular ducts during 
surgery and to ensure that they will be patent at the end 
of the procedure. 

TECHNIQUE 

The following items are needed to cannulate a sub- 
mandibular duct: lacrimal dilators in sizes 1, 2, and 3; 
lacrimal probes in sizes 00 through 6; and a 14-18 gauge 
intravenous catheter. 

Local anesthesia is accomplished so as not to distort 
the tissue to be removed for biopsy. The duct orifice is 
located, dilated and probed with successively larger 
lacrimal probes up to the size 6 probe. Salivary flow is 
checked and the catheter sutured into position. (Both 
submandibular ducts can be cannulated for midline 
lesions.) During the surgical procedure, an assistant 
can hold the catheter to the side, ensuring a clear field 
of vision for the biopsy and closure. If the oral surgeon 
is concerned that duct patency may be reduced or oblit- 
erated during healing, the catheter may be left in place 
after the operation and checked periodically for patency 
and salivary flow. 

If a portion of the duct is removed with the tissue 
specimen, the catheter may be used to position the new 
duct orifice. This catheter should be left in place for 10 
to 14 days or until epithelialization is complete. The 
catheter may be removed after the wound closes and 
healing progresses without complications. 



CAPT Mosby is an oral surgeon on the staff of the Dental Service, 
Naval Regional Medical Center, Great Lakes, 111. 60088. He thanks 
PH2 R.M. Smith and the Fleet Training Center photographic labora- 
tory, Naval Station San Diego, for their assistance with this article. 




Typical midline floor ol mouth lesion, visually obscuring sub- 
mandibular ducts. 




Above left: Both ducts are cannulated and retracted. The 
lesion could be excised without repositioning the ducts, since 
it does not actually involve them. Right: The wound has been 
closed with catheters still in place. 




Surgical area one week after surgery, 
closer together, but both are patent. 



Note that ducts are 



24 



U.S. Navy Medicine 



Hypertension Screening Aboard Ship 



LCDR E. Wayne Massey, MC, USNR 



The arbitrary value of 150/90 has 
generally been accepted as a defini- 
tion of hypertension — a "silent 
disease" that produces no symp- 
toms until it is well advanced and 
considerable damage has occurred. 
Under the 150/90 standard, as 
many as 15% of U.S. men in their 
30's and 20% of men in their 50's 
can be considered hypertensive (7). 
But some scientists believe that 
optimal blood pressure for adults 
may be below 120/80, and that in- 
creased mortality may result with 
elevations of only 10 to 20 milli- 
meters of mercury (2). Also, blood 
pressure is known to rise with in- 
creasing age until around the age of 
60, when the blood pressure may be 
140/90. 

All these facts make the task of 
defining hypertension more diffi- 
cult, but do not lessen the impor- 
tance of defining, controlling and 
preventing this disease. 

Elevated blood pressure may lead 
to coronary artery atherosclerosis 
and cerebral atherosclerosis (3). 
Cerebral artery aneurysms are more 
common in hypertension (1), as are 
changes in renal parenchyma, heart 
muscle, vessel walls and other 
organs. Although most hyperten- 
sion is diagnosed as "essential," or 
unknown, blood pressure elevations 
may be caused by increased release 
of renin from the kidney, increased 
renin substrate (such as may occur 
during pregnancy or in women 
taking contraceptive steroids), and 
primary increases in aldosterone 



LCDR Massey is on the staff of the Neurol- 
ogy Service, National Naval Medical Center, 
Bethesda. Md. 20014. At the time this article 
was written, he was participating in the Fleet 
Medical Pool Program as medical officer in 
the USS Trenton. 



from adenomas, hyperplastic adre- 
nal glands, or other forms of 
adrenal pathology. The value of 
blood pressure control in reducing 
the incidence of strokes and heart 
failure is well established, and early 
diagnosis and treatment of hyper- 
tension is recognized as an impor- 
tant part of preventive medical care. 
Hypertension is not a rarity in 
childhood, as physicians once 
thought. Some studies have re- 
vealed that 6% of young people 
from age 1 day to 18 years may have 
hypertension (4); among youths 
aged 12 to 24 years, as many as 
11% may have the disease (5,6). 
Examination for hypertension 
should not be overlooked when 
physicians treat these young pa- 
tients. 

SHIPBOARD SCREENING 

Because hypertension can so 
easily go undetected, especially 
among young people, we undertook 
blood pressure checkups for the 
454-man crew of the USS Trenton 
(LPD-14) during the ship's return 
from a Mediterranean cruise. The 
value used to screen the men was 
140/90 — in conformance with the 
Manual of the Medical Department. 

We also checked the men's 
weight, and recommended diet and 
exercise for overweight members. 

Eleven sailors were found to have 
elevated blood pressures (four 
others were known hypertensives 
already being treated). In followup, 
3 of these 11 men had lower blood 
pressures than on their initial 
check, and they were advised to 
have periodic checks over the next 
year. The other eight men had con- 
tinued elevated blood pressure and 
were referred to the Hypertension 



Clinic at Naval Regional Medical 
Center Portsmouth, Va., for evalua- 
tion, counseling, and medication as 
needed. The men's ages ranged 
from 18 to 37 years, and the highest 
blood pressure was 180/120. Some 
of these men may eventually drop 
back to a "normal" blood pressure 
range, but they will all continue to 
need frequent checks. 

This type of shipboard screening 
program would be a success if only 
one man was diagnosed as hyper- 
tensive and the course of his disease 
altered, but to identify so many 
previously unknown problems was 
unusually rewarding. Including the 
already known hypertensives, the 
prevalence of hypertension on board 
a Navy ship with a crew of "healthy 
young men" was a remarkable 
2.7%. 

Other ship medical departments 
may wish to undertake this type of 
relatively easy and rewarding blood 
pressure screening program. 

REFERENCES 

1. Arteriosclerosis (National Heart and 
Lung Institute Task Force on Arteriosclero- 
sis), Dept of Health, Education and Welfare 
Pub. No. (NIH) 72-219, Vol. 2. National In- 
stitutes of Health, June 1971. 

2. Oberman A, Harlan WR, Smith M, et 
al: The cardiovascular risk: Associated with 
different levels and type of elevated blood 
pressure. Minn Med 52:1283-1288, 1969. 

3. Baker AB, Resch JA, Loewenson RB: 
Hypertension and cerebral atherosclerosis. 
Circulation 39:701-710, 1969. 

4. Londe S: Blood pressure in children as 
determined under office conditions. Clin 
Pediatr (Phila) 5:71, 1966. 

5. Heyden S, Barrel AG, Hanes CG, et 
al: Elevated blood pressure levels in adoles- 
cents. Evans County, Georgia: Seven-year 
follow-up of 30 patients and 30 controls. 
JAMA 209:1683, 1969. 

6. Loggie J: Essential hypertension in 
adolescents. Postgrad Med 56(6):133-H2, 
Nov 1974. 



Volume 68, October 1977 



25 



Professional 



The Efficacy of the CMI and MMPI as 
Predictors of Successful Completion 
of Psychiatric Technician Training 



LT John J. Penkunas, MSC, USN 
CAPT John F. McGrail, MC, USN 



Escalating costs and high attrition rates associated 
with the Navy's various training programs have been 
the concern of many investigators. Arthur's compre- 
hensive article {1) reviewed the various techniques 
that have been employed to minimize attrition rates 
in such programs. Some investigators have used 

"odds for effectiveness" scores, to predict the suc- 
cessful completion of training. For example, in 1972, 
Biersner (2) found that a special subscale of the 
Cornell Medical Index (CMI), when combined with 
the Physical Fitness Scales, was a useful predictor of 
successful completion of the Navy's Underwater 
Demolition Training Program. In the civilian sector, 
early investigators found that two psychological tests 
—a revised Beta Examination and a Multiple Choice 
Rorschach— satisfactorily differentiated the "defi- 
nitely good" group from the "definitely bad" group 
of psychiatric aides training at Connecticut State 
Hospital (3). 

The psychiatric technician school at Naval 
Regional Medical Center Philadelphia provided an 
excellent opportunity to study factors possibly rele- 
vant to an individual's ability to successfully com- 
plete an extensive and demanding psychiatric tech- 
nician training program. This program began 
training hospital corpsmen in April 1949, and gradu- 
ated its final class in July 1976; the Navy then en- 
tered into a tri-service psychiatric technician training 
program in which the academic portion is coordi- 
nated at a training center in San Antonio, Tex., and 



From the Naval Regional Medical Center, Philadelphia, Pa. 
19145, where LT Penkunas is a clinical psychologist and CAPT 
McGrail is chairman, Department of Psychiatry. 



the clinical experience is provided later at certain 
Navy psychiatric residency training centers. 

In the earlier psychiatric technician training pro- 
gram, Navy psychiatrists, psychologists, psychiatric 
nurses, and enlisted instructors provided students 
with both lectures and clinical training. The primary 



~ IxluIlLxx inir^iuiv^ mugipmi VYQi? 



to enable students to acquire the principles, skills 
and techniques they needed to be effective psychiat- 
ric technicians. To successfully complete the pro- 
gram, students had to maintain a satisfactory 
academic average as well as demonstrate certain 
clinical skills on the wards. The psychiatric courses, 
close preceptorship and clinical experience were all 
designed to help the students develop various posi- 
tive, therapeutic characteristics— including toler- 
ance, flexibility, compassion, and an objective, 
rational approach to a patient's problems. 

A potential psychiatric technician trainee must be 
a volunteer who has had no appreciable administra- 
tive or disciplinary difficulties; the candidate must 
have successfully completed a basic Hospital Corps 
School course in general medical/surgical patient 
care, and have a combined GCT-ARI score of 105. A 
medical/psychiatric screening interview is some- 
times required. Psychological testing has not, to 
date, been a regular part of screening applicants for 
Navy psychiatric technician training programs. 

We undertook this study to determine whether the 
Minnesota Multiphasic Personality Inventory 
(MMPI) and the Cornell Medical Index (CMI) would 
be useful in predicting which students would suc- 
cessfully complete the academic and clinical instruc- 
tion required of psychiatric technician trainees . The 
null hypothesis states that there are no significant 



26 



U.S. Navy Medicine 



differences between the test scores of the disenrolled 
and the graduated groups of students. We hope that 
our research might provide an adjunctive tool for 
screening and selecting Navy psychiatric technician 
training program candidates, 

METHOD 

All 39 students comprising the last three classes of 
psychiatric technician trainees served as subjects for 
the study. Before each class began, every student 
was administered the MMPI and the CMI. 

The MMPI is an extensively used "objective" 
personality test which has ten empirically con- 
structed clinical scales and three validity scales 
designed to assess the subject's test-taking attitude. 
The MMPI asks the subject to make a self-report on 
566 items dealing with religious, political, and sexual 
attitudes, general health, mood, interests, pre- 
occupations, and abnormal experiences (4). 

The CMI is a self-administered instrument which 
requires the subject to report on 100 items concern- 
ing various neuropsychiatric and psychosomatic 
symptoms. The CMI has been used repeatedly as a 
valid indicator of both general health and emotional 
stability in a variety of populations and cultures (5) . 

To avoid the pitfalls of self-fulfilling-prophecy type 
phenomena such as described by Rosenthal (6), we 
used a "blind" design. Numbers, rather than the 
students' names, were placed on test materials. 
Neither the researchers nor the psychiatric techni- 
cian school faculty could relate test results to the 
identity of the subjects. The psychiatric nursing 
supervisor who held the list of students' names and 
assigned numbers did not have access to the test 
materials (which were kept by the junior author). 
Also, the psychiatric nursing supervisor was not 
associated with the psychiatric technician school, 
and therefore could not influence the students' suc- 
cess or failure. 

Each MMPI was computer-scored by a national 
service; the CMIs were scored by the junior author. 

Two groups of subjects— those graduated and 
those disenrolled— were formed after the com- 
mencement exercises of each class. There were 30 
subjects in the graduated group and 9 subjects in the 
disenrolled group. 

RESULTS 

Statistical analyses of the data (T-tests, see Table 
I) showed that the graduated subjects differed signif- 
icantly from the disenrolled group on the CMI and 



TABLE I. A Comparison of Differences of Mean Scores 
of Disenrolled and Graduated Groups 





Disenrolled Group vs. 


Scale 


Graduated Males 


Graduated Both Sexes 


Validity Scales 






L 


.969 


.744 


F 


1.594 


1.733 


K 


3.903" 


3.836** 


Clinical Scales 






{K-corrected) 






Hs 


.368 


.171 


D 


.626 


.686 


Hy 


1.269 


.468 


Pd 


.542 


.698 


Mf 


.199 


NA 


Pa 


1.130 


1.282 


Pt 


.228 


.0789 


Sc 


1.359 


1.666 


Ma 


2.529* 


2.654* 


Si 


.504 


.384 




df=32 


df=37 



.01 level (2 tailed) 
.05 level (2 tailed) 



two MMPI scales: the K scale (sometimes referred to 
as a correction or "suppressor variable" scale), 
which measures the degree of conscious or uncon- 
scious defensiveness in the subject's test-taking 
attitude; and the Ma or "hypomanic" scale, which 
measures the personality factor characteristic of 
overproductivity in thought and action {7,8). The dis- 
enrolled group scored in the pathological direction 
on these three scales. 

On the MMPI, the graduated group's mean K 
score was 19.46, which is equivalent to a T-score of 
approximately 64; the disenrolled group's mean K 
score was 14.66— or a T-score of 54. Such a differ- 
ence suggests that the disenrolled group had a more 
self-critical test-taking attitude than did the gradu- 
ated group. Although the K scale is affected by the 
subject's socioeconomic and educational back- 
ground, there were no significant differences be- 
tween the two groups on these variables. 

On the Ma scale, the graduated group's K-cor- 
rected mean score was 21.10— equivalent to a T- 
score of 61 and well within the normal range. How- 
ever, the disenrolled group's mean score on the Ma 
scale was 25.22— in the pathological range since it is 
equal to a T-score of 71. From such a difference the 



Volume 68, October 1977 



27 



inference can be drawn that some persons in the dis- 
enrolled group were troubled by an overproductivity 
of thought and action. People with high Ma scores 
often get into trouble because they undertake too 
many projects and soon lose interest in them. Such 
people have been described as overtalkative, dis- 
tractible, and restless. Corpsmen with such traits 
would not be good candidates for psychiatric techni- 
cian training, which requires workers to make many 
rational judgments while providing care for psychiat- 
ric patients. 

On the CMI, the disenrolled group's mean score 
was 10.11, whereas the graduated group's mean 
score was 4.00 (p<.01, t = 3.965, df = 37). The disen- 
rolled group gave positive answers to items concern- 
ing various psychosomatic and anxiety-type com- 
plaints 2.7 times more frequently than did subjects 
in the graduating group. The elevated mean score of 
the disenrolled group approximated the mean score 
of the people on whom the CMI was standardized in 
1948— people who had serious neuropsychiatry and 
psychosomatic disturbances {9). If CMI scores of 13 
and higher were used as a cutoff point, the attrition 
rate would have been 19%, which is not a major im- 
provement over the 23% attrition rate that occurs 
when no psychological tests are used (Table II). In 
other words, there were statistically significant dif- 
ferences between the mean scores of the disenrolled 
and graduated subjects but no practical differences 
between the groups, since no cutoff score would 
have markedly improved the attrition rate. 

Table II shows how certain cutoff scores would have 
reduced the attrition rate for the psychiatric techni- 
cian trainees we studied. In the table, cutoff scores 
are arranged in an increasing order of effectiveness. 
The most effective combination of cutoff scores— the 



TABLE II. Psychiatric Technician School Attrition Rate 

as a Function of Cutoff Scores from 

Psychological Test Scales 



Cutoff scores Attrition rate 


Students eliminated 






Disenrolled 


Graduated 






group 


group 


None used 


23% 






CMI (13 and higher) 


19% 


2 


1 


Ma {28 and higher) 


14% 


4 


1 


K (14 and lower) 


13% 


5 


3 


Ma (28 and higher) •* 

and \ 

K (14 and lower) J 








8% 


3 












K and Ma scales of the MMPI— would have elimi- 
nated three students from the disenrolled group but 
none from the graduated group. 

DISCUSSION 

The null hypothesis was rejected because there 
were statistically significant differences between the 
test scores of the graduated and disenrolled groups. 
Moreover, if cutoff scores were selected from the 
scales on which the groups differed to a statistically 
significant degree, dramatic changes in the attrition 
rates would be realized. 

An attrition rate of 23 % prevailed for the last three 
Navy psychiatric technician training classes, in 
which the standard MMPI and CMI were not used to 
screen students before they began training. Our re- 
search suggests that selecting students based on 
MMPI scores of 28 and higher on the Ma scale and 
14 and lower on the K scale would have reduced the 
attrition rate to 8%. Stated differently, with this 
selection criteria only 1 of 12 students would have 
been disenrolled, rather than 1 of 4. 

The CMI proved to be a statistically valid screen- 
ing device in our study, although it did not compare 
with the apparent immediate practical application of 
the MMPI. We postulate that if a larger number of 
subjects were studied, useful predictive CMI scores 
might be developed. 

In 1976 Booth and his associates (10) reported a 
27% attrition rate for the Hospital Corps "A" 
School*. These investigators uncovered a variable 
work-role motivation which would have reduced that 
attrition rate to 13%. They concluded that Navy en- 
listees who elected to work in the paramedical field 
were more likely to complete training than were 
enlistees who did not have a strong preference to 
serve in that field. 

All the psychiatric technician students we studied 
were essentially volunteers who had completed Hos- 
pital Corps "A" School. However, since June 1970 
the attrition rate for the psychiatric technician school 
at NRMC Philadelphia has been 26%. Booth's find- 
ings that volunteers were more successful than non- 
volunteers in completing paramedical training pro- 
grams suggest that a much lower attrition rate 
should have prevailed, notwithstanding the espe- 
cially demanding aspects of such training. 



*Hospital Corps "A" School essentially consists of 14 weeks of 
lectures and practical training in the fundamentals of anatomy 
and physiology, pharmacy and toxicology, preventive medicine, 
first aid and emergency treatment, and nursing procedures. 



28 



U.S. Navy Medicine 



We postulate that the difference between the 
actual attrition rate among Navy psychiatric techni- 
cian trainees and the rate that might have been ex- 
pected is related to the especially complex factors 
that enter into an individual selecting this particular 
type of training. To function proficiently as a care- 
giver in a Navy psychiatry setting, the prospective 
psychiatric technician must be essentially free of 
serious psychological disturbance when he or she 
enters the training program. 

CONCLUSION 

In this study, we tested the validity of the assump- 
tion that to the extent a corpsman chooses psychiat- 
ric technician training for reasons having to do with 
unresolved and unrecognized conflicts, psychological 
testing should be useful in detecting evidences of 
such predominately unconscious motives. Our find- 
ings support the belief that psychological test 
screening would be a useful adjunct in selecting in- 
dividuals for this training program. 

If our study can be replicated, volunteers selected 
for psychiatric technician training would have a 
greater chance of successfully completing the pro- 
gram; candidates unlikely to succeed would not be 
selected for training, and would thus be spared the 
emotional stress of failure. Such screening could be 
conducted at the prospective trainee's duty station, 
and individuals with scores at or near the cutoff point 
could be considered more closely before being 
selected for psychiatric technician training. 

With the advent of tri-service training for military 
psychiatric technicians, and the attendant provision 
of the didactic experience in one geographic location 
and the clinical experience at a different location, the 
need for improved screening procedures and associ- 
ated cost savings will probably be greater in the 
future than it is now. 



SUMMARY 

This study used a blind research design to assess 
the usefulness of employing the MMPI and CMI as 
adjuncts to screening volunteers for Navy psychiatric 
technician training. We found that such testing— 
especially MMPI testing— would be valuable, since 
adherence to certain cutoff scores could appreciably 
lower the attrition rate among trainees. Lowered 
attrition would result in cost savings to the govern- 
ment and lessen unnecessary emotional trauma by 
sparing some candidates the stress of failure. The 
benefits of improved screening procedures will be 
increasingly important in tri-service psychiatric tech- 
nician training programs. 

REFERENCES 

1. Arthur RJ: Success is predictable. Milit Med 136:539-546, 
1971. 

2. BiersnerRJ, Gunderson EKE, Eyman DH, Rahe RH: Cor- 
relations of physical fitness, perceived health status, and dispen- 
sary visits with performance in stressful training. J Sports Med 
Phys Fitness 12:107-110, 1972. 

3. Yerbury EC, Holzberg JO, Alessi S: Psychological tests in 
the selection and placement of psychiatric aides. Am J Psychiatry 
108:91-98, 1951. 

4. Cronbach LJ: Essentials of Psychological Testing, ed 3. 
New York, Harper & Rowe, 1970. 

5. Abramson JH: The Cornell Medical Index as an epidemio- 
logical tool. Am J Public Health 56:287-298, 1966. 

6. Rosenthal R, Jacobson L: Pygmalion in the Classroom. 
New York, Holt Rinehart & Winston Inc., 1968. 

7. Dunlop E: Essentials of the Automated MMPI. Glendale, 
Calif., Institute of Clinical Analysis, 1966, pp 18-34. 

8. Good DKL, Brantner JP: The Physician's Guide to the 
MMPI. Minneapolis, University of Minnesota Press, 1961, pp 15- 
16. 

9. Weider A, Wolff HG, Brodman K, Mittelman B, Wechsler 
D: Manual for Cornell Medical Index. New York, The Psychologi- 
cal Corporation, 1948. 

10. Booth RF, Hoiberg AL, Webster E: Work role motivation 
as a predictor of success in Navy paramedical training. Milit Med 
141:183, 1976. 



Volume 68, October 1977 



29 



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